Transapical aortic valve replacement is a safe option in patients with poor left ventricular ejection fraction: Results from the Italian Transcatheter Balloon-Expandable Registry (ITER)

Augusto D'Onofrio, Stefano Salizzoni, Claudia Filippini, Marco Agrifoglio, Ottavio Alfieri, Alaide Chieffo, Giuseppe Tarantini, Davide Gabbieri, Carlo Savini, Sebastiano Immè, Flavio Ribichini, Diego Cugola, Eliana Raviola, Bruno Loi, Esmeralda Pompei, Antioco Cappai, Mauro Cassese, Giampaolo Luzi, Marco Aiello, Francesco SantiniMauro Rinaldi, Gino Gerosa

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVES: The most commonly used accesses for transcatheter aortic valve implantation (TAVI) are the transfemoral (TF-TAVI) and the transapical (TA-TAVI) ones. There are concerns about TA-TAVI use in patients with reduced left ventricular ejection fraction (LVEF). The aim of this retrospective multicentre study was to compare the outcomes of TA-TAVI and TF-TAVI in patients with poor LVEF. METHODS: Patients with LVEF < 35% were included in the analysis. Data were obtained from the Italian Transcatheter Balloon-Expandable Registry (ITER), which enrolled patients undergoing TAVI with the Sapien bioprosthesis in 33 national centres. Patients were divided into 2 groups according to the access: TA or TF. A multivariable logistic regression analysis was performed in order to evaluate whether the type of approach (TA and TF) has an impact on outcomes. RESULTS: Between 2007 and 2012, 1882 patients were enrolled in the Registry. LVEF < 35% was found in 208 (11.1%) patients. TA-TAVI and TF-TAVI were performed in 69 (33.2%) and 139 (66.8%) patients, respectively. Overall 30-day mortality was 11.6% and 7.9% in TA and TF patients, respectively (P = 0.45). Overall Kaplan-Meier survival was significantly higher in the TF-TAVI group (log rank: P = 0.003). Age [odds ratio (OR) 1.066, P = 0.016], creatinine (OR: 2.301, P < 0.001), preoperative permanent pacemaker (OR: 4.662, P = 0.035) and TA approach (OR: 2.577, P = 0.006) were identified as independent predictors of overall mortality at follow-up. However, the TA approach resulted an independent variable of mortality only 3 years after TAVI. CONCLUSIONS: TAVI yields good results in patients with depressed LVEF. Age, preoperative creatinine and preoperative pacemaker are independently associated with mortality. The TA access is associated with mortality only after 3 years of follow-up, thus probably reflecting a worse general clinical status of these patients.

Original languageEnglish
Pages (from-to)874-880
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume52
Issue number5
DOIs
Publication statusPublished - Jan 1 2017

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Aortic Valve
Stroke Volume
Registries
Odds Ratio
Mortality
Creatinine
Bioprosthesis
Transcatheter Aortic Valve Replacement
Multicenter Studies
Retrospective Studies
Logistic Models
Regression Analysis
Survival

Keywords

  • Aortic valve
  • Left ventricular ejection fraction
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Transapical aortic valve replacement is a safe option in patients with poor left ventricular ejection fraction : Results from the Italian Transcatheter Balloon-Expandable Registry (ITER). / D'Onofrio, Augusto; Salizzoni, Stefano; Filippini, Claudia; Agrifoglio, Marco; Alfieri, Ottavio; Chieffo, Alaide; Tarantini, Giuseppe; Gabbieri, Davide; Savini, Carlo; Immè, Sebastiano; Ribichini, Flavio; Cugola, Diego; Raviola, Eliana; Loi, Bruno; Pompei, Esmeralda; Cappai, Antioco; Cassese, Mauro; Luzi, Giampaolo; Aiello, Marco; Santini, Francesco; Rinaldi, Mauro; Gerosa, Gino.

In: European Journal of Cardio-thoracic Surgery, Vol. 52, No. 5, 01.01.2017, p. 874-880.

Research output: Contribution to journalArticle

D'Onofrio, A, Salizzoni, S, Filippini, C, Agrifoglio, M, Alfieri, O, Chieffo, A, Tarantini, G, Gabbieri, D, Savini, C, Immè, S, Ribichini, F, Cugola, D, Raviola, E, Loi, B, Pompei, E, Cappai, A, Cassese, M, Luzi, G, Aiello, M, Santini, F, Rinaldi, M & Gerosa, G 2017, 'Transapical aortic valve replacement is a safe option in patients with poor left ventricular ejection fraction: Results from the Italian Transcatheter Balloon-Expandable Registry (ITER)', European Journal of Cardio-thoracic Surgery, vol. 52, no. 5, pp. 874-880. https://doi.org/10.1093/ejcts/ezx227
D'Onofrio, Augusto ; Salizzoni, Stefano ; Filippini, Claudia ; Agrifoglio, Marco ; Alfieri, Ottavio ; Chieffo, Alaide ; Tarantini, Giuseppe ; Gabbieri, Davide ; Savini, Carlo ; Immè, Sebastiano ; Ribichini, Flavio ; Cugola, Diego ; Raviola, Eliana ; Loi, Bruno ; Pompei, Esmeralda ; Cappai, Antioco ; Cassese, Mauro ; Luzi, Giampaolo ; Aiello, Marco ; Santini, Francesco ; Rinaldi, Mauro ; Gerosa, Gino. / Transapical aortic valve replacement is a safe option in patients with poor left ventricular ejection fraction : Results from the Italian Transcatheter Balloon-Expandable Registry (ITER). In: European Journal of Cardio-thoracic Surgery. 2017 ; Vol. 52, No. 5. pp. 874-880.
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abstract = "OBJECTIVES: The most commonly used accesses for transcatheter aortic valve implantation (TAVI) are the transfemoral (TF-TAVI) and the transapical (TA-TAVI) ones. There are concerns about TA-TAVI use in patients with reduced left ventricular ejection fraction (LVEF). The aim of this retrospective multicentre study was to compare the outcomes of TA-TAVI and TF-TAVI in patients with poor LVEF. METHODS: Patients with LVEF < 35{\%} were included in the analysis. Data were obtained from the Italian Transcatheter Balloon-Expandable Registry (ITER), which enrolled patients undergoing TAVI with the Sapien bioprosthesis in 33 national centres. Patients were divided into 2 groups according to the access: TA or TF. A multivariable logistic regression analysis was performed in order to evaluate whether the type of approach (TA and TF) has an impact on outcomes. RESULTS: Between 2007 and 2012, 1882 patients were enrolled in the Registry. LVEF < 35{\%} was found in 208 (11.1{\%}) patients. TA-TAVI and TF-TAVI were performed in 69 (33.2{\%}) and 139 (66.8{\%}) patients, respectively. Overall 30-day mortality was 11.6{\%} and 7.9{\%} in TA and TF patients, respectively (P = 0.45). Overall Kaplan-Meier survival was significantly higher in the TF-TAVI group (log rank: P = 0.003). Age [odds ratio (OR) 1.066, P = 0.016], creatinine (OR: 2.301, P < 0.001), preoperative permanent pacemaker (OR: 4.662, P = 0.035) and TA approach (OR: 2.577, P = 0.006) were identified as independent predictors of overall mortality at follow-up. However, the TA approach resulted an independent variable of mortality only 3 years after TAVI. CONCLUSIONS: TAVI yields good results in patients with depressed LVEF. Age, preoperative creatinine and preoperative pacemaker are independently associated with mortality. The TA access is associated with mortality only after 3 years of follow-up, thus probably reflecting a worse general clinical status of these patients.",
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T1 - Transapical aortic valve replacement is a safe option in patients with poor left ventricular ejection fraction

T2 - Results from the Italian Transcatheter Balloon-Expandable Registry (ITER)

AU - D'Onofrio, Augusto

AU - Salizzoni, Stefano

AU - Filippini, Claudia

AU - Agrifoglio, Marco

AU - Alfieri, Ottavio

AU - Chieffo, Alaide

AU - Tarantini, Giuseppe

AU - Gabbieri, Davide

AU - Savini, Carlo

AU - Immè, Sebastiano

AU - Ribichini, Flavio

AU - Cugola, Diego

AU - Raviola, Eliana

AU - Loi, Bruno

AU - Pompei, Esmeralda

AU - Cappai, Antioco

AU - Cassese, Mauro

AU - Luzi, Giampaolo

AU - Aiello, Marco

AU - Santini, Francesco

AU - Rinaldi, Mauro

AU - Gerosa, Gino

PY - 2017/1/1

Y1 - 2017/1/1

N2 - OBJECTIVES: The most commonly used accesses for transcatheter aortic valve implantation (TAVI) are the transfemoral (TF-TAVI) and the transapical (TA-TAVI) ones. There are concerns about TA-TAVI use in patients with reduced left ventricular ejection fraction (LVEF). The aim of this retrospective multicentre study was to compare the outcomes of TA-TAVI and TF-TAVI in patients with poor LVEF. METHODS: Patients with LVEF < 35% were included in the analysis. Data were obtained from the Italian Transcatheter Balloon-Expandable Registry (ITER), which enrolled patients undergoing TAVI with the Sapien bioprosthesis in 33 national centres. Patients were divided into 2 groups according to the access: TA or TF. A multivariable logistic regression analysis was performed in order to evaluate whether the type of approach (TA and TF) has an impact on outcomes. RESULTS: Between 2007 and 2012, 1882 patients were enrolled in the Registry. LVEF < 35% was found in 208 (11.1%) patients. TA-TAVI and TF-TAVI were performed in 69 (33.2%) and 139 (66.8%) patients, respectively. Overall 30-day mortality was 11.6% and 7.9% in TA and TF patients, respectively (P = 0.45). Overall Kaplan-Meier survival was significantly higher in the TF-TAVI group (log rank: P = 0.003). Age [odds ratio (OR) 1.066, P = 0.016], creatinine (OR: 2.301, P < 0.001), preoperative permanent pacemaker (OR: 4.662, P = 0.035) and TA approach (OR: 2.577, P = 0.006) were identified as independent predictors of overall mortality at follow-up. However, the TA approach resulted an independent variable of mortality only 3 years after TAVI. CONCLUSIONS: TAVI yields good results in patients with depressed LVEF. Age, preoperative creatinine and preoperative pacemaker are independently associated with mortality. The TA access is associated with mortality only after 3 years of follow-up, thus probably reflecting a worse general clinical status of these patients.

AB - OBJECTIVES: The most commonly used accesses for transcatheter aortic valve implantation (TAVI) are the transfemoral (TF-TAVI) and the transapical (TA-TAVI) ones. There are concerns about TA-TAVI use in patients with reduced left ventricular ejection fraction (LVEF). The aim of this retrospective multicentre study was to compare the outcomes of TA-TAVI and TF-TAVI in patients with poor LVEF. METHODS: Patients with LVEF < 35% were included in the analysis. Data were obtained from the Italian Transcatheter Balloon-Expandable Registry (ITER), which enrolled patients undergoing TAVI with the Sapien bioprosthesis in 33 national centres. Patients were divided into 2 groups according to the access: TA or TF. A multivariable logistic regression analysis was performed in order to evaluate whether the type of approach (TA and TF) has an impact on outcomes. RESULTS: Between 2007 and 2012, 1882 patients were enrolled in the Registry. LVEF < 35% was found in 208 (11.1%) patients. TA-TAVI and TF-TAVI were performed in 69 (33.2%) and 139 (66.8%) patients, respectively. Overall 30-day mortality was 11.6% and 7.9% in TA and TF patients, respectively (P = 0.45). Overall Kaplan-Meier survival was significantly higher in the TF-TAVI group (log rank: P = 0.003). Age [odds ratio (OR) 1.066, P = 0.016], creatinine (OR: 2.301, P < 0.001), preoperative permanent pacemaker (OR: 4.662, P = 0.035) and TA approach (OR: 2.577, P = 0.006) were identified as independent predictors of overall mortality at follow-up. However, the TA approach resulted an independent variable of mortality only 3 years after TAVI. CONCLUSIONS: TAVI yields good results in patients with depressed LVEF. Age, preoperative creatinine and preoperative pacemaker are independently associated with mortality. The TA access is associated with mortality only after 3 years of follow-up, thus probably reflecting a worse general clinical status of these patients.

KW - Aortic valve

KW - Left ventricular ejection fraction

KW - Transcatheter aortic valve implantation

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