The effect of transcatheter aortic valve implantation approaches on mortality

Vincent J Nijenhuis; Alexander Meyer; Jorn Brouwer; Bakhtawar K Mahmoodi; Axel Unbehaun; Marco Spaziano; Nicola Buzzatti; Anja Stundl; Troels H Jørgensen; Nynke H M Kooistra; Marianna Adamo; Smriti Saraf; Hafid Amrane; Giuseppe Bruschi; Carlo Zivelonghi; Martin J Swaans; Nikos Werner; Georg Nickenig; David Hildick-Smith; Pieter R Stella; Azeem Latib; Lars Soendergaard; Jan-Malte Sinning; Thierry Lefevre; Miralem Pasic; Jorg Kempfert; Jurrien M Ten Berg

doi:10.1002/ccd.29456

The effect of transcatheter aortic valve implantation approaches on mortality

Vincent J Nijenhuis, Alexander Meyer, Jorn Brouwer, Bakhtawar K Mahmoodi, Axel Unbehaun, Marco Spaziano, Nicola Buzzatti, Anja Stundl, Troels H Jørgensen, Nynke H M Kooistra, Marianna Adamo, Smriti Saraf, Hafid Amrane, Giuseppe Bruschi, Carlo Zivelonghi, Martin J Swaans, Nikos Werner, Georg Nickenig, David Hildick-Smith, Pieter R StellaAzeem Latib, Lars Soendergaard, Jan-Malte Sinning, Thierry Lefevre, Miralem Pasic, Jorg Kempfert, Jurrien M Ten Berg

Afdeling for Hjertesygdomme

3 Citationer (Scopus)

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.

Originalsprog	Engelsk
Tidsskrift	Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Vol/bind	97
Udgave nummer	7
Sider (fra-til)	1462-1469
Antal sider	8
ISSN	1522-1946
DOI	https://doi.org/10.1002/ccd.29456
Status	Udgivet - 1 jun. 2021

Adgang til dokumentet

10.1002/ccd.29456

Andre filer og links

Link to publication in Scopus

Citationsformater

Nijenhuis, V. J., Meyer, A., Brouwer, J., Mahmoodi, B. K., Unbehaun, A., Spaziano, M., Buzzatti, N., Stundl, A., Jørgensen, T. H., Kooistra, N. H. M., Adamo, M., Saraf, S., Amrane, H., Bruschi, G., Zivelonghi, C., Swaans, M. J., Werner, N., Nickenig, G., Hildick-Smith, D., ... Ten Berg, J. M. (2021). The effect of transcatheter aortic valve implantation approaches on mortality. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 97(7), 1462-1469. https://doi.org/10.1002/ccd.29456

The effect of transcatheter aortic valve implantation approaches on mortality. / Nijenhuis, Vincent J; Meyer, Alexander; Brouwer, Jorn et al.
I: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Bind 97, Nr. 7, 01.06.2021, s. 1462-1469.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Nijenhuis, VJ, Meyer, A, Brouwer, J, Mahmoodi, BK, Unbehaun, A, Spaziano, M, Buzzatti, N, Stundl, A, Jørgensen, TH, Kooistra, NHM, Adamo, M, Saraf, S, Amrane, H, Bruschi, G, Zivelonghi, C, Swaans, MJ, Werner, N, Nickenig, G, Hildick-Smith, D, Stella, PR, Latib, A, Soendergaard, L, Sinning, J-M, Lefevre, T, Pasic, M, Kempfert, J & Ten Berg, JM 2021, 'The effect of transcatheter aortic valve implantation approaches on mortality', Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, bind 97, nr. 7, s. 1462-1469. https://doi.org/10.1002/ccd.29456

@article{27995e4019c24fbd83a944d541b8b979,

title = "The effect of transcatheter aortic valve implantation approaches on mortality",

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.",

keywords = "Aortic Valve/diagnostic imaging, Aortic Valve Stenosis/diagnostic imaging, Humans, Prospective Studies, Stroke Volume, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome, Ventricular Function, Left",

author = "Nijenhuis, {Vincent J} and Alexander Meyer and Jorn Brouwer and Mahmoodi, {Bakhtawar K} and Axel Unbehaun and Marco Spaziano and Nicola Buzzatti and Anja Stundl and J{\o}rgensen, {Troels H} and Kooistra, {Nynke H M} and Marianna Adamo and Smriti Saraf and Hafid Amrane and Giuseppe Bruschi and Carlo Zivelonghi and Swaans, {Martin J} and Nikos Werner and Georg Nickenig and David Hildick-Smith and Stella, {Pieter R} and Azeem Latib and Lars Soendergaard and Jan-Malte Sinning and Thierry Lefevre and Miralem Pasic and Jorg Kempfert and {Ten Berg}, {Jurrien M}",

note = "{\textcopyright} 2021 Wiley Periodicals LLC.",

year = "2021",

month = jun,

day = "1",

doi = "10.1002/ccd.29456",

language = "English",

volume = "97",

pages = "1462--1469",

journal = "Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions",

issn = "1522-1946",

publisher = "John Wiley and Sons Inc.",

number = "7",

}

TY - JOUR

T1 - The effect of transcatheter aortic valve implantation approaches on mortality

AU - Nijenhuis, Vincent J

AU - Meyer, Alexander

AU - Brouwer, Jorn

AU - Mahmoodi, Bakhtawar K

AU - Unbehaun, Axel

AU - Spaziano, Marco

AU - Buzzatti, Nicola

AU - Stundl, Anja

AU - Jørgensen, Troels H

AU - Kooistra, Nynke H M

AU - Adamo, Marianna

AU - Saraf, Smriti

AU - Amrane, Hafid

AU - Bruschi, Giuseppe

AU - Zivelonghi, Carlo

AU - Swaans, Martin J

AU - Werner, Nikos

AU - Nickenig, Georg

AU - Hildick-Smith, David

AU - Stella, Pieter R

AU - Latib, Azeem

AU - Soendergaard, Lars

AU - Sinning, Jan-Malte

AU - Lefevre, Thierry

AU - Pasic, Miralem

AU - Kempfert, Jorg

AU - Ten Berg, Jurrien M

PY - 2021/6/1

Y1 - 2021/6/1

N2 - 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.

AB - 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.

KW - Aortic Valve/diagnostic imaging

KW - Aortic Valve Stenosis/diagnostic imaging

KW - Humans

KW - Prospective Studies

KW - Stroke Volume

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Treatment Outcome

KW - Ventricular Function, Left

UR - http://www.scopus.com/inward/record.url?scp=85107401983&partnerID=8YFLogxK

U2 - 10.1002/ccd.29456

DO - 10.1002/ccd.29456

M3 - Journal article

C2 - 33443813

SN - 1522-1946

VL - 97

SP - 1462

EP - 1469

JO - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

IS - 7

ER -

The effect of transcatheter aortic valve implantation approaches on mortality

Abstract

Adgang til dokumentet

Andre filer og links

Fingeraftryk

Citationsformater