Trans‐subclavian versus transapical access for transcatheter aortic valve implantation: A multicenter study. Issue 2 (22nd May 2015)

• Record Type: Journal Article
• Authors: Ciuca, Cristina; Tarantini, Giuseppe; Latib, Azeem; Gasparetto, Valeria; Savini, Carlo; Di Eusanio, Marco; Napodano, Massimo; Maisano, Francesco; Gerosa, Gino; Sticchi, Alessandro; Marzocchi, Antonio; Alfieri, Ottavio; Colombo, Antonio; Saia, Francesco
• Is Part Of: Catheterization and cardiovascular interventions. Volume 87:Issue 2(2016)
• Page Start: 332
• Page End: 338
• Publication Date: 2015-05-22
• Subjects: aortic stenosis -- transcatheter aortic valve replacement -- vascular access -- outcome; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.26012
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract : Objectives: To compare the outcomes of trans‐subclavian (TS) and transapical (TA) access for transcatheter aortic valve implantation (TAVI). Background: A considerable proportion of patients undergoing TAVI are not eligible for transfemoral approach. To date, there are few data to guide the choice between alternative vascular access routes. Methods: Among 874 consecutive patients who underwent TAVI, 202 procedures were performed through TA ( n = 142, 70.3%) or TS ( n = 60, 29.7%) access. Medtronic Corevalve (CV, Medtronic, Minneapolis, MN) was implanted in 17.3% of the patients, the Edwards‐Sapien (ES, Edwards Lifesciences Inc., Irvine, CA) in 81.2% and other prostheses in 0.1%. In‐hospital and long‐term outcome were assessed using the Valve Academic Research Consortium (VARC)‐2 definitions. Results: Mean age was 82 ± 6 years, STS score 9.3 ± 7.9%. The 2 groups showed a relevant imbalance in baseline characteristics. In hospital mortality was 6.4% (1.7% TS vs. 8.4% TA, P = 0.06), stroke 2.0%, acute myocardial infarction 1.0%, acute kidney injury 39.4%, sepsis 4.0% with no significant differences between groups, while bleeding was more frequent in TA patients (53.5% vs. 11.7% TS, P < 0.001). One‐ and 2‐year survival was 85.2% and 73.2% in TS patients, and 83.9% and 74.9% in TA patients ( P = ns for both). Access site was not an independent predictor of mortality at multivariable analysis. Conclusion: Transapical compared with trans‐subclavian access for TAVI was associated with a nonsignificant trend to increased periprocedural events. However, 1‐ and 2‐year survival appears similar. © 2015 Wiley Periodicals, Inc.