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)

A. D'Onofrio, S. Salizzoni, C. Filippini, M. Agrifoglio, O. Alfieri, A. Chieffo, G. Tarantini, D. Gabbieri, C. Savini, S. Immè, F. Ribichini, D. Cugola, E. Raviola, B. Loi, E. Pompei, A. Cappai, M. Cassese, G. Luzi, M. Aiello, F. SantiniM. Rinaldi, G. Gerosa

Research output: Contribution to journalArticlepeer-review

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. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Original languageEnglish
Pages (from-to)874-880
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume52
Issue number5
DOIs
Publication statusPublished - 2017

Keywords

  • Aortic valve
  • Left ventricular ejection fraction
  • Transcatheter aortic valve implantation
  • aged
  • aortic regurgitation
  • Article
  • controlled study
  • device safety
  • EuroSCORE
  • female
  • follow up
  • heart left ventricle ejection fraction
  • human
  • independent variable
  • informed consent
  • intraoperative period
  • major clinical study
  • male
  • mitral valve regurgitation
  • new-onset atrial fibrillation
  • population research
  • preoperative period
  • priority journal
  • surgical mortality
  • transcatheter aortic valve implantation

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