Beyond the Learning Curve: Transapical Versus Transfemoral Transcatheter Aortic Valve Replacement in the Treatment of Severe Aortic Valve Stenosis. Issue 3 (7th March 2014)

• Record Type: Journal Article
• Authors: Greason, Kevin L.; Suri, Rakesh M.; Nkomo, Vuyisile T.; Rihal, Charanjit S.; Holmes, David R.; Mathew, Verghese
• Is Part Of: Journal of cardiac surgery. Volume 29:Issue 3(2014:May)
• Page Start: 303
• Page End: 307
• Publication Date: 2014-03-07
• Subjects: Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.12323
• Languages: English
• ISSNs: 0886-0440

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="jocs12323-sec-0001" sec-type="section"> <title>Background</title> <p>Most studies comparing transapical and transfemoral transcatheter aortic valve replacement include the center's early operative experience, which may negatively impact the outcomes. This study reports our experience beyond the learning curve with transapical and transfemoral transcatheter aortic valve replacement.</p> </sec> <sec id="jocs12323-sec-0002" sec-type="section"> <title>Methods</title> <p>A total of 303 patients underwent transcatheter aortic valve replacement from November 2008 through August 2013. There were 153 patients (50.5%) who received transfemoral valve replacement, 130 (42.9%) received transapical valve replacement, and 20 (6.6%) received transaortic valve replacement. We retrospectively reviewed the outcomes of the most recent 100 consecutive patients each from the transfemoral and transapical valve replacement groups.</p> </sec> <sec id="jocs12323-sec-0003" sec-type="section"> <title>Results</title> <p>The median age was 82 years (range, 54 to 95) and 110 patients (55%) were male; STS predicted risk of mortality was 8.1% (0.7 to 27.8) and was similar between groups (p = 0.256). Operative complications occurred in 49 patients (49%) in the transapical replacement group and in 43 (43%) in the transfemoral group (p = 0.478). Vascular complications occurred only in the transfemoral group and included nine patients (9%; p = 0.003). Paravalvular regurgitation at discharge of grade mild–moderate occurred in 23 patients (24.2%) in the transapical group in comparison to 40 (43.5%) in the transfemoral group (p = 0.006). Operative mortality occurred in two patients (2%) in the transapical group and in five (5%) in the transfemoral group (p = 0.445).</p> </sec> <sec id="jocs12323-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Transapical transcatheter aortic valve replacement is associated with less prevalence of vascular complications and mild–moderate paravalvular regurgitation in comparison to the transfemoral approach. Further study is necessary to determine if the transapical technique is the preferred option. doi: 10.1111/jocs.12323 <italic>(J Card Surg 2014;29:303–307)</italic></p> </sec> </abstract>