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

Research output: Contribution to journalArticle

25 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

Fingerprint

Safety
Survival Rate
Transcatheter Aortic Valve Replacement
Kaplan-Meier Estimate
Prostheses and Implants
Mortality

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Direct Comparison of Feasibility and Safety of Transfemoral Versus Transaortic Versus Transapical Transcatheter Aortic Valve Replacement. / Arai, Takahide; Romano, Mauro; Lefèvre, Thierry; Hovasse, Thomas; Farge, Arnaud; Le Houerou, Daniel; Hayashida, Kentaro; Watanabe, Yusuke; Garot, Philippe; Benamer, Hakim; Unterseeh, Thierry; Bouvier, Erik; Morice, Marie Claude; Chevalier, Bernard.

In: JACC: Cardiovascular Interventions, Vol. 9, No. 22, 28.11.2016, p. 2320-2325.

Research output: Contribution to journalArticle

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, MC & Chevalier, B 2016, 'Direct Comparison of Feasibility and Safety of Transfemoral Versus Transaortic Versus Transapical Transcatheter Aortic Valve Replacement', JACC: Cardiovascular Interventions, vol. 9, no. 22, pp. 2320-2325. https://doi.org/10.1016/j.jcin.2016.08.009
Arai, Takahide ; Romano, Mauro ; Lefèvre, Thierry ; Hovasse, Thomas ; Farge, Arnaud ; Le Houerou, Daniel ; Hayashida, Kentaro ; Watanabe, Yusuke ; Garot, Philippe ; Benamer, Hakim ; Unterseeh, Thierry ; Bouvier, Erik ; Morice, Marie Claude ; Chevalier, Bernard. / Direct Comparison of Feasibility and Safety of Transfemoral Versus Transaortic Versus Transapical Transcatheter Aortic Valve Replacement. In: JACC: Cardiovascular Interventions. 2016 ; Vol. 9, No. 22. pp. 2320-2325.
@article{3932ea275fe747dc8f53be45a7cf0641,
title = "Direct Comparison of Feasibility and Safety of Transfemoral Versus Transaortic Versus Transapical Transcatheter Aortic Valve Replacement",
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.",
keywords = "severe symptomatic aortic stenosis, transaortic, transapical, transcatheter aortic valve replacement, transfemoral",
author = "Takahide Arai and Mauro Romano and Thierry Lef{\`e}vre and Thomas Hovasse and Arnaud Farge and {Le Houerou}, Daniel and Kentaro Hayashida and Yusuke Watanabe and Philippe Garot and Hakim Benamer and Thierry Unterseeh and Erik Bouvier and Morice, {Marie Claude} and Bernard Chevalier",
year = "2016",
month = "11",
day = "28",
doi = "10.1016/j.jcin.2016.08.009",
language = "English",
volume = "9",
pages = "2320--2325",
journal = "JACC: Cardiovascular Interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "22",

}

TY - JOUR

T1 - Direct Comparison of Feasibility and Safety of Transfemoral Versus Transaortic Versus Transapical Transcatheter Aortic Valve Replacement

AU - Arai, Takahide

AU - Romano, Mauro

AU - Lefèvre, Thierry

AU - Hovasse, Thomas

AU - Farge, Arnaud

AU - Le Houerou, Daniel

AU - Hayashida, Kentaro

AU - Watanabe, Yusuke

AU - Garot, Philippe

AU - Benamer, Hakim

AU - Unterseeh, Thierry

AU - Bouvier, Erik

AU - Morice, Marie Claude

AU - Chevalier, Bernard

PY - 2016/11/28

Y1 - 2016/11/28

N2 - 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.

AB - 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.

KW - severe symptomatic aortic stenosis

KW - transaortic

KW - transapical

KW - transcatheter aortic valve replacement

KW - transfemoral

UR - http://www.scopus.com/inward/record.url?scp=84997132290&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84997132290&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2016.08.009

DO - 10.1016/j.jcin.2016.08.009

M3 - Article

C2 - 27884356

AN - SCOPUS:84997132290

VL - 9

SP - 2320

EP - 2325

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1936-8798

IS - 22

ER -