Propensity-Matched Comparisons of Clinical Outcomes After Transapical or Transfemoral Transcatheter Aortic Valve Replacement. Issue 22 (2nd June 2015)

• Record Type: Journal Article
• Authors: Blackstone, Eugene H.; Suri, Rakesh M.; Rajeswaran, Jeevanantham; Babaliaros, Vasilis; Douglas, Pamela S.; Fearon, William F.; Miller, D. Craig; Hahn, Rebecca T.; Kapadia, Samir; Kirtane, Ajay J.; Kodali, Susheel K.; Mack, Michael; Szeto, Wilson Y.; Thourani, Vinod H.; Tuzcu, E. Murat; Williams, Mathew R.; Akin, Jodi J.; Leon, Martin B.; Svensson, Lars G.
• Is Part Of: Circulation. Volume 131:Issue 22(2015)
• Publication Date: 2015-06-02
• Subjects: Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.114.012525
• Languages: English
• ISSNs: 0009-7322

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p>The higher risk of adverse outcomes after transapical (TA) versus transfemoral (TF) transcatheter aortic valve replacement (TAVR) could be attributable to TA-TAVR being an open surgical procedure or to clinical differences between TA- and TF-TAVR patients. We compared outcomes after neutralizing patient differences using propensity score matching.</p> </sec> <sec> <title>Methods and Results—</title> <p>From April 2007 to February 2012, 1100 Placement of Aortic Transcatheter Valves (PARTNER)-I patients underwent TA-TAVR and 1521 underwent TF-TAVR with Edwards SAPIEN balloon-expandable bioprostheses. Propensity matching based on 111 preprocedural variables, exclusive of femoral access morphology, identified 501 well-matched patient pairs (46% of possible matches), 95% of whom had peripheral arterial disease. Matched TA-TAVR patients experienced more adverse procedural events, longer length of stay (5 versus 8 days; <italic>P</italic><0.0001), and slower recovery (New York Heart Association class I, 31% versus 38% at 30 days, equalizing by 6 months at 51% versus 47%); stroke risk was similar (3.4% versus 3.3% at 30 days and 6.0% versus 6.7% at 3 years); mortality was elevated for the first 6 postprocedural months (19% versus 12%; <italic>P</italic>=0.01); but aortic regurgitation was less (34% versus 52% mild and 8.9% versus 12% moderate to severe at discharge, <italic>P</italic>=0.001; 36% versus 50% mild and 10% versus 15% moderate to severe at 6 months, <italic>P</italic><0.0001).</p> </sec> <sec> <title>Conclusions—</title> <p>The likelihood of adverse periprocedural events and prolonged recovery is greater after TA-TAVR than TF-TAVR in vasculopathic patients after accounting for differences in cardiovascular risk factors, although stroke risk is equivalent and aortic regurgitation is less. As smaller delivery systems permit TF-TAVR in many of these patients, we recommend a TF-first access strategy for TAVR when anatomically feasible.</p> </sec> <sec> <title>Clinical Trial Registration—</title> <p>URL: <ext-link ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.clinicaltrials.gov</ext-link>. Unique identifier: NCT00530894.</p> </sec> </abstract>