Direct Comparison of Feasibility and Safety of Transfemoral Versus Transaortic Versus Transapical Transcatheter Aortic Valve Replacement

Takahide Arai, Mauro Romano, Thierry Lefèvre, Thomas Hovasse, Arnaud Farge, Daniel Le Houerou, Kentaro Hayashida, Yusuke Watanabe, Philippe Garot, Hakim Benamer, Thierry Unterseeh, Erik Bouvier, Marie Claude Morice, Bernard Chevalier

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32 Citations (Scopus)

Abstract

Objectives The aim of this study was to compare outcomes among transfemoral (TF), transaortic (TAo), and transapical (TA) transcatheter aortic valve replacement (TAVR). Background Very few studies have investigated the differences among TF, TAo, and TA TAVR in terms of safety and feasibility. Methods Between January 2011 and December 2014, 467 consecutive cases of TF TAVR, 289 cases of TAo TAVR, and 42 cases of TA TAVR were analyzed. Baseline characteristics, procedural characteristics, and outcomes were compared between TF and TAo and between TAo and TA approaches. Results Balloon-expandable prostheses were used in 320 cases of TF TAVR (69%), 209 cases of TAo TAVR (72%), and all cases of TA TAVR. The remaining cases were performed using self-expandable prostheses. Patient age and Society of Thoracic Surgeons score were similar (83.8 years vs. 83.7 years vs. 81.3 years and 6.2% vs. 5.8% vs. 7.1%) among all groups. Although nonsignificant, a trend toward lower 30-day mortality (5% vs. 9%; p = 0.057) was observed with TF TAVR compared with TAo TAVR. Kaplan-Meier analysis revealed a trend toward a higher 1-year survival rate (log-rank p = 0.067) with TF TAVR compared with TAo TAVR. There was no significant difference in 30-day mortality between TAo and TA TAVR (9% vs. 14%; p = 0.283). Kaplan-Meier analysis revealed a trend toward a higher 1-year survival rate (log-rank p = 0.154) with TAo TAVR compared with TA TAVR. Conclusions Although the 30-day mortality and 1-year survival rates were similar between TF and TAo TAVR patients, a trend in favor of the TF approach was observed. In addition, the TAo approach can be considered as an alternative to the TA approach when the TF approach seems unsuitable.

Original languageEnglish
Pages (from-to)2320-2325
Number of pages6
JournalJACC: Cardiovascular Interventions
Volume9
Issue number22
DOIs
Publication statusPublished - 2016 Nov 28

Keywords

  • severe symptomatic aortic stenosis
  • transaortic
  • transapical
  • transcatheter aortic valve replacement
  • transfemoral

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Arai, T., Romano, M., Lefèvre, T., Hovasse, T., Farge, A., Le Houerou, D., Hayashida, K., Watanabe, Y., Garot, P., Benamer, H., Unterseeh, T., Bouvier, E., Morice, M. C., & Chevalier, B. (2016). Direct Comparison of Feasibility and Safety of Transfemoral Versus Transaortic Versus Transapical Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions, 9(22), 2320-2325. https://doi.org/10.1016/j.jcin.2016.08.009