Transapical versus transfemoral aortic valve implantation: A multicenter collaborative study

Robert M A Van Der Boon, Bertrand Marcheix, Didier Tchetche, Alaide Chieffo, Nicolas M. Van Mieghem, Nicolas Dumonteil, Olivier Vahdat, Francesco Maisano, Patrick W. Serruys, A. Pieter Kappetein, Jean Fajadet, Antonio Colombo, Didier Carrié, Ron T. Van Domburg, Peter P T De Jaegere

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Abstract

Background There are no direct comparisons between transapical aortic valve implantation (TA-AVI) and transfemoral aortic valve implantation (TF-AVI). Therefore, the aim of this study was to compare the short-term and midterm outcomes of TA-AVI versus TF-AVI. Methods Data from four European centers were pooled and analyzed. To minimize differences between TA-AVI and TF-AVI multivariable analysis was used. Study endpoints were defined according to the Valve Academic Research Consortium-I criteria at 30 days and 1 year. Primary endpoints of this study were 30-day all-cause mortality and mortality during follow-up. Results A total of 882 patients underwent TAVI, of whom 793 (89.9%) underwent TF-AVI and 89 (10.1%) underwent TA-AVI. Patients undergoing TA-AVI had a higher estimated risk of mortality as defined by the logistic European System for Cardiac Operative Risk Evaluation score (median 27.0, interquartile range [IQR]: 20.2 to 33.8 versus median 20.0, IQR: 12.3 to 27.7; p <0.001) and The Society of Thoracic Surgeons Score (median 10.2, IQR: 5.3 to 9.9 versus median 6.7, IQR: 3.5 to 9.9; p <0.001) and had more comorbidities. At 30 days, there was an increased risk of all-cause mortality in the TA-AVI group (odds ratio [OR] 3.12, 95% confidence interval [CI]: 1.43 to 6.82; p = 0.004). TF-AVI was associated with a higher frequency of major (OR 0.33, 95% CI: 0.12 to 0.90; p = 0.031) and minor vascular complications (OR 0.17, 95% CI: 0.04 to 0.71; p = 0.0015). In-hospital stay was significantly longer among patients undergoing TA-AVI (OR 2.29, 95% CI: 1.28 to 4.09; p = 0.05). During a median follow-up of 365 days (IQR: 174 to 557), TA-AVI was associated with an increased risk of all-cause mortality (hazard ratio 1.88, 95% CI: 1.23 to 2.87; p = 0.004). Conclusions In institutions performing a low volume of TA-AVI, the technique is associated with an increased risk of all-cause mortality and longer hospital stay but less vascular complications in comparison with TF-AVI. The interaction between experience and type of treatment on outcome requires further investigation before advocating one treatment over the other.

Original languageEnglish
Pages (from-to)22-28
Number of pages7
JournalAnnals of Thoracic Surgery
Volume97
Issue number1
DOIs
Publication statusPublished - Jan 2014

ASJC Scopus subject areas

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

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    Van Der Boon, R. M. A., Marcheix, B., Tchetche, D., Chieffo, A., Van Mieghem, N. M., Dumonteil, N., Vahdat, O., Maisano, F., Serruys, P. W., Kappetein, A. P., Fajadet, J., Colombo, A., Carrié, D., Van Domburg, R. T., & De Jaegere, P. P. T. (2014). Transapical versus transfemoral aortic valve implantation: A multicenter collaborative study. Annals of Thoracic Surgery, 97(1), 22-28. https://doi.org/10.1016/j.athoracsur.2013.09.088