The effect of transcatheter aortic valve implantation approaches on mortality. Issue 7 (14th January 2021)

• Record Type: Journal Article
• Authors: Nijenhuis, Vincent J.; Meyer, Alexander; Brouwer, Jorn; Mahmoodi, Bakhtawar K.; Unbehaun, Axel; Spaziano, Marco; Buzzatti, Nicola; Stundl, Anja; Jørgensen, Troels H.; Kooistra, Nynke H.M.; Adamo, Marianna; Saraf, Smriti; Amrane, Hafid; Bruschi, Giuseppe; Zivelonghi, Carlo; Swaans, Martin J.; Werner, Nikos; Nickenig, Georg; Hildick‐Smith, David; Stella, Pieter R.; Latib, Azeem; Soendergaard, Lars; Sinning, Jan‐Malte; Lefevre, Thierry; Pasic, Miralem; Kempfert, Jorg; ten Berg, Jurrien M.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 97:Issue 7(2021)
• Page Start: 1462
• Page End: 1469
• Publication Date: 2021-01-14
• Subjects: access -- left ventricular ejection fraction -- propensity -- survival -- transcatheter aortic valve replacement -- transfemoral; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.29456
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: We aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) approaches on mortality and identify effect modifiers and predictors for mortality. Background: Alternative access routes to transfemoral (TF) TAVI include the surgical intra‐thoracic direct‐aortic (DA) and transapical (TA) approach. TA TAVI has been associated with a higher mortality rate. We hypothesized that this is related to effect modifiers, in particular the left ventricular ejection fraction (LVEF). Methods: This multicentre study derived its data from prospective registries. To adjust for confounders, we used propensity‐score based, stabilized inverse probability weighted Cox regression models. Results: In total, 5, 910 patients underwent TAVI via TF ( N = 4, 072), DA ( N = 524), and TA ( N = 1, 314) access. Compared to TF, 30‐day mortality was increased among DA (HR 1.87, 95%CI 1.26–2.78, p = .002) and TA (HR 3.34, 95%CI 2.28–4.89, p < .001) cases. Compared to TF, 5‐year mortality was increased among TA cases (HR 1.50, 95%CI 1.24–1.83, p < .001). None of the variables showed a significant interaction between the approaches and mortality. An impaired LVEF (≤35%) increased mortality in all approaches. Conclusions: The surgical intra‐thoracic TA and DA TAVI are both associated with a higher 30‐day mortality than TF TAVI. TA TAVI is associated with a higher 5‐year mortality than TF TAVI. The DA approach may therefore have some advantages over the TA approach when TF access is not feasible.