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Comparison of the Transarterial and Transthoracic Approaches in Nontransfemoral Transcatheter Aortic Valve Implantation.

Author information

Affiliations

  • 1. University of Rennes 1, Cardiology and Vascular Diseases Department, Pontchaillou University Hospital, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.
      Authors
    • Beve M 1
    • Auffret V 1
    • Boulmier D 1
    • Bedossa M 1
    • Leurent G 1
    • Donal E 1
    • Le Breton H 1
    (7 authors)
  • 2. University of Rennes 1, Cardiac, Thoracic, and Vascular Surgery Department, Pontchaillou University Hospital, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.
      Authors
    • Belhaj Soulami R 2
    • Tomasi J 2
    • Anselmi A 2
    • Verhoye JP 2
    (4 authors)
  • 3. University of Rennes 1, Cardiac, Thoracic, and Vascular Surgery Department, Pontchaillou University Hospital, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France; Anesthesiology Department, Pontchaillou University Hospital, Rennes, France.
      Authors
    • Roisne A 3
    (1 author)

ORCIDs linked to this article

The American Journal of Cardiology, 08 Feb 2019, 123(9):1501-1509
https://doi.org/10.1016/j.amjcard.2019.01.040 PMID: 30777318 

Abstract 

Transfemoral approach stands as the reference access-route for transcatheter aortic valve implantation (TAVI). Nonetheless, alternatives approaches are still needed in a significant proportion of patients. This study aimed at comparing outcomes between transthoracic-approach (transapical or transaortic) and transarterial-approach (transcarotid or subclavian) TAVI. Data from 191 consecutive patients who underwent surgical-approach TAVI from May 2009 to September 2017 were analyzed. Patients were allocated in 2 groups according to the approach. The primary end point was the 30-day composite of death of any cause, need for open surgery, tamponade, stroke, major or life-threatening bleeding, stage 2 or 3 acute kidney injury, coronary obstruction, or major vascular complications. During the study period, 104 patients underwent transthoracic TAVI (transapical: 60.6%, transaortic: 39.4%) whereas 87 patients underwent transarterial TAVI (subclavian: 83.9%, transcarotid: 16.1%). Logistic EuroSCORE I tended to be higher in transthoracic-TAVI recipients. In-hospital and 30-day composite end point rates were 25.0% and 11.5% (p = 0.025), and 26.0% and 14.9% (p = 0.075) for the transthoracic and transarterial cohorts, respectively. Propensity score-adjusted logistic regression demonstrated no significant detrimental association between the 30-day composite end point and transthoracic access (odds ratio 2.12 95% confidence interval 0.70 to 6.42; p = 0.18). Transarterial TAVI was associated with a shorter length of stay (median: 6 vs 7 days, p <0.001). TAVI approach was not an independent predictor of midterm mortality. In conclusion, nontransfemoral transarterial-approach TAVI is safe, feasible, and associated with comparable rates of major perioperative complications, and midterm mortality compared with transthoracic-approach TAVI.

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Read article at publisher's site: https://doi.org/10.1016/j.amjcard.2019.01.040

Read article for free, from open access legal sources, via Unpaywall: http://manuscript.elsevier.com/S0002914919301687/pdf/S0002914919301687.pdfUnpaywall

HAL Open Archive
https://hal-univ-rennes1.archives-ouvertes.fr/hal-02049700

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