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

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.

OriginalsprogEngelsk
TidsskriftCatheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Vol/bind97
Udgave nummer7
Sider (fra-til)1462-1469
Antal sider8
ISSN1522-1946
DOI
StatusUdgivet - 1 jun. 2021

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