Details

Autor(en) / Beteiligte

• BLACKMAN, DANIEL J.
• BAXTER, PAUL D.
• GALE, CHRIS P.
• MOAT, NEIL E.
• MACCARTHY, PHILIP A.
• HILDICK-SMITH, DAVID
• TRIVEDI, UDAY
• CUNNINGHAM, DAVID
• DE BELDER, MARK A.
• LUDMAN, PETER F.

Titel

Do Outcomes from Transcatheter Aortic Valve Implantation Vary According to Access Route and Valve Type? The UK TAVI Registry

Ist Teil von

• Journal of interventional cardiology, 2014-02, Vol.27 (1), p.86-95

Ort / Verlag

United States: Blackwell Publishing Ltd

Erscheinungsjahr

2014

Quelle

EZB-FREE-00999 freely available EZB journals

Beschreibungen/Notizen

• Objectives To determine whether outcomes from transcatheter aortic valve implantation (TAVI) vary according to access route and valve type in a real‐world population. Background Registry and uncontrolled trial data have found that patients undergoing nonfemoral TAVI have higher early and late mortality. It is not clear whether worse outcomes relate directly to access route. There have been no direct comparisons of outcomes according to valve type. Methods Data were collected prospectively on 1,620 patients undergoing TAVI in the UK and compared in 4 groups: SAPIEN transfemoral (TF); SAPIEN transapical (TA); CoreValve TF, CoreValve subclavian. Univariable and multivariable regression analysis was performed to identify independent predictors of mortality. Results Mortality in patients undergoing SAPIEN TAVI via a TA approach was higher than with TF at 30 days (11.2% vs. 4.4%, P < 0.01), 1 year (28.7% vs. 18.1%, P = 0.01), and 2 years (56.0% vs. 43.5%, P = 0.01). Logistic EuroSCORE was higher in TA patients (22.5 ± 12.9% vs. 17.7 ± 11.1%, P < 0.0001). After multivariable analysis TA access was associated with increased mortality at 30 days (OR 2.56, 95% CI 1.46–4.48, P < 0.01) and 2 years (OR 1.75, 1.08–2.74, P = 0.02). There was no significant difference in mortality at any time‐point between patients treated with SAPIEN (n = 812) and CoreValve (n = 808) prostheses. CoreValve‐treated patients had a higher rate of permanent pacemaker implantation (23.1% vs. 7.2%, P < 0.0001), and grade ≥2 aortic regurgitation on postprocedure echocardiography (13.0% vs. 7.3%, P < 0.01). Conclusions Patients undergoing TA TAVI experienced increased early and late mortality compared to a TF approach. Survival was not influenced by valve type. (J Interven Cardiol 2014;27:86–95)