Transapical approach versus transcervical approach for transcatheter aortic valve replacement: a retrospective monocentric study. (14th October 2020)

• Record Type: Journal Article
• Authors: Lu, Henri; Fournier, Stephane; Namasivayam, Jegaruban; Roguelov, Christian; Ferrari, Enrico; Eeckhout, Eric; Monney, Pierre; Tozzi, Piergiorgio; Marcucci, Carlo; Muller, Olivier; Kirsch, Matthias
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 31:Number 6(2020)
• Page Start: 781
• Page End: 788
• Publication Date: 2020-10-14
• Subjects: Aortic valve stenosis -- Transcatheter aortic valve replacement -- Transapical -- Transcervical; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivaa202
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: Transfemoral approach is the standard access-route for transcatheter aortic valve replacement (TAVR). However, alternative approaches are needed in a number of patients and accesses such as transapical (TA) TAVR or transcervical (TC) are used. We aimed to compare clinical and echocardiographic outcomes after TA-TAVR or TC-TAVR. METHODS: All patients who underwent TA- and TC-TAVR for severe aortic stenosis in our institution between 2008 and 2020 were retrospectively included. End points included 30-day all-cause mortality, procedural complications (according to the Valve Academic Research Consortium-2 criteria), procedure duration, intensive care unit (ICU) length of stay (LOS) and overall hospital LOS. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as difference in year of intervention. RESULTS: TAVR was performed in 176 patients, using a TA approach ( n = 127) or a TC approach ( n = 49). Baseline clinical and echocardiographic characteristics were comparable between the 2 groups, except age and peripheral artery disease. All-cause 30-day mortality rates were not significantly different (8.5% in the TA group vs 2.3% in the TC group, P = 0.124). TC approach was associated with significantly shorter procedure duration {71.0 [interquartile range (IQR) 52.5–101.0] vs 93 [IQR 80.0–120.0] min, P < 0.001}, shorter ICU LOS [0.0 (IQR 0.0–0.0) vs 1.0 (IQR 1.0–3.0) days, P < 0.001] and shorter hospital LOS [7.0 (IQR 5.0–9.5) vs 14.0 (IQR 10.0–22.0) days, P < 0.001]. CONCLUSIONS: The TC approach may be a good first-choice alternative in case of contraindications to transfemoral-TAVR. Abstract : Since its first description in 2002 [1], transcatheter aortic valve replacement (TAVR) has become an alternative to surgical aortic valve replacement for patients presenting with severe aortic stenosis, in particular those aged ≥70 [2, 3].