Similar 5-Year Survival in Transfemoral and Transapical TAVI Patients: A Single-Center Experience
Transapical transcatheter aortic valve implantation (TA-TAVI) is generally considered to be associated with increased morbidity and mortality compared with transfemoral transcatheter aortic valve implantation TAVI (TF-TAVI). We aimed to compare different patient risk profiles, access-related complic...
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| Vydáno v: | Bioengineering (Basel) Ročník 10; číslo 2; s. 156 |
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24.01.2023
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| Abstract | Transapical transcatheter aortic valve implantation (TA-TAVI) is generally considered to be associated with increased morbidity and mortality compared with transfemoral transcatheter aortic valve implantation TAVI (TF-TAVI). We aimed to compare different patient risk profiles, access-related complications, and long-term survival using inverse probability treatment weighting. This is a retrospective, single-center analysis of 925 consecutive patients with aortic valve stenosis undergoing TF-TAVI (n = 802) or TA-TAVI (n = 123) at the University Hospital Basel, Switzerland, as a single procedure between September 2011 and August 2020. Baseline characteristics revealed a higher perioperative risk as reflected in the EuroSCORE II (geometric mean 2.3 (95% confidence interval (CI) 2.2 to 2.4) vs. 3.7 (CI 3.1 to 4.5); before inverse probability of treatment weighting (IPTW) p < 0.001) in the transfemoral than in the transapical group, respectively. After 30 days, TF-TAVI patients had a higher incidence of any bleeding than TA-TAVI patients (TF-TAVI n = 146 vs. TA-TAVI n = 15; weighted hazard ratio (HR) 0.52 (0.29 to 0.95); p = 0.032). After 5 years, all-cause mortality did not differ between the two groups (TF-TAVI n = 162 vs. TA-TAVI n = 45; weighted HR 1.31, (0.92 to 1.88); p = 0.138). With regard to our data, we could demonstrate, despite a higher perioperative risk, the short- and long-term safety and efficacy of the transapical approach for TAVI therapies. Though at higher perioperative risk, transapically treated patients suffered from less bleeding or vascular complications than transfemorally treated patients. It is of utmost interest that 5-year mortality did not differ between the groups. |
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| AbstractList | Transapical transcatheter aortic valve implantation (TA-TAVI) is generally considered to be associated with increased morbidity and mortality compared with transfemoral transcatheter aortic valve implantation TAVI (TF-TAVI). We aimed to compare different patient risk profiles, access-related complications, and long-term survival using inverse probability treatment weighting. This is a retrospective, single-center analysis of 925 consecutive patients with aortic valve stenosis undergoing TF-TAVI (n = 802) or TA-TAVI (n = 123) at the University Hospital Basel, Switzerland, as a single procedure between September 2011 and August 2020. Baseline characteristics revealed a higher perioperative risk as reflected in the EuroSCORE II (geometric mean 2.3 (95% confidence interval (CI) 2.2 to 2.4) vs. 3.7 (CI 3.1 to 4.5); before inverse probability of treatment weighting (IPTW) p < 0.001) in the transfemoral than in the transapical group, respectively. After 30 days, TF-TAVI patients had a higher incidence of any bleeding than TA-TAVI patients (TF-TAVI n = 146 vs. TA-TAVI n = 15; weighted hazard ratio (HR) 0.52 (0.29 to 0.95); p = 0.032). After 5 years, all-cause mortality did not differ between the two groups (TF-TAVI n = 162 vs. TA-TAVI n = 45; weighted HR 1.31, (0.92 to 1.88); p = 0.138). With regard to our data, we could demonstrate, despite a higher perioperative risk, the short- and long-term safety and efficacy of the transapical approach for TAVI therapies. Though at higher perioperative risk, transapically treated patients suffered from less bleeding or vascular complications than transfemorally treated patients. It is of utmost interest that 5-year mortality did not differ between the groups. Transapical transcatheter aortic valve implantation (TA-TAVI) is generally considered to be associated with increased morbidity and mortality compared with transfemoral transcatheter aortic valve implantation TAVI (TF-TAVI). We aimed to compare different patient risk profiles, access-related complications, and long-term survival using inverse probability treatment weighting. This is a retrospective, single-center analysis of 925 consecutive patients with aortic valve stenosis undergoing TF-TAVI (n = 802) or TA-TAVI (n = 123) at the University Hospital Basel, Switzerland, as a single procedure between September 2011 and August 2020. Baseline characteristics revealed a higher perioperative risk as reflected in the EuroSCORE II (geometric mean 2.3 (95% confidence interval (CI) 2.2 to 2.4) vs. 3.7 (CI 3.1 to 4.5); before inverse probability of treatment weighting (IPTW) p < 0.001) in the transfemoral than in the transapical group, respectively. After 30 days, TF-TAVI patients had a higher incidence of any bleeding than TA-TAVI patients (TF-TAVI n = 146 vs. TA-TAVI n = 15; weighted hazard ratio (HR) 0.52 (0.29 to 0.95); p = 0.032). After 5 years, all-cause mortality did not differ between the two groups (TF-TAVI n = 162 vs. TA-TAVI n = 45; weighted HR 1.31, (0.92 to 1.88); p = 0.138). With regard to our data, we could demonstrate, despite a higher perioperative risk, the short- and long-term safety and efficacy of the transapical approach for TAVI therapies. Though at higher perioperative risk, transapically treated patients suffered from less bleeding or vascular complications than transfemorally treated patients. It is of utmost interest that 5-year mortality did not differ between the groups.Transapical transcatheter aortic valve implantation (TA-TAVI) is generally considered to be associated with increased morbidity and mortality compared with transfemoral transcatheter aortic valve implantation TAVI (TF-TAVI). We aimed to compare different patient risk profiles, access-related complications, and long-term survival using inverse probability treatment weighting. This is a retrospective, single-center analysis of 925 consecutive patients with aortic valve stenosis undergoing TF-TAVI (n = 802) or TA-TAVI (n = 123) at the University Hospital Basel, Switzerland, as a single procedure between September 2011 and August 2020. Baseline characteristics revealed a higher perioperative risk as reflected in the EuroSCORE II (geometric mean 2.3 (95% confidence interval (CI) 2.2 to 2.4) vs. 3.7 (CI 3.1 to 4.5); before inverse probability of treatment weighting (IPTW) p < 0.001) in the transfemoral than in the transapical group, respectively. After 30 days, TF-TAVI patients had a higher incidence of any bleeding than TA-TAVI patients (TF-TAVI n = 146 vs. TA-TAVI n = 15; weighted hazard ratio (HR) 0.52 (0.29 to 0.95); p = 0.032). After 5 years, all-cause mortality did not differ between the two groups (TF-TAVI n = 162 vs. TA-TAVI n = 45; weighted HR 1.31, (0.92 to 1.88); p = 0.138). With regard to our data, we could demonstrate, despite a higher perioperative risk, the short- and long-term safety and efficacy of the transapical approach for TAVI therapies. Though at higher perioperative risk, transapically treated patients suffered from less bleeding or vascular complications than transfemorally treated patients. It is of utmost interest that 5-year mortality did not differ between the groups. Transapical transcatheter aortic valve implantation (TA-TAVI) is generally considered to be associated with increased morbidity and mortality compared with transfemoral transcatheter aortic valve implantation TAVI (TF-TAVI). We aimed to compare different patient risk profiles, access-related complications, and long-term survival using inverse probability treatment weighting. This is a retrospective, single-center analysis of 925 consecutive patients with aortic valve stenosis undergoing TF-TAVI (n = 802) or TA-TAVI (n = 123) at the University Hospital Basel, Switzerland, as a single procedure between September 2011 and August 2020. Baseline characteristics revealed a higher perioperative risk as reflected in the EuroSCORE II (geometric mean 2.3 (95% confidence interval (CI) 2.2 to 2.4) vs. 3.7 (CI 3.1 to 4.5); before inverse probability of treatment weighting (IPTW) < 0.001) in the transfemoral than in the transapical group, respectively. After 30 days, TF-TAVI patients had a higher incidence of any bleeding than TA-TAVI patients (TF-TAVI n = 146 vs. TA-TAVI n = 15; weighted hazard ratio (HR) 0.52 (0.29 to 0.95); = 0.032). After 5 years, all-cause mortality did not differ between the two groups (TF-TAVI n = 162 vs. TA-TAVI n = 45; weighted HR 1.31, (0.92 to 1.88); = 0.138). With regard to our data, we could demonstrate, despite a higher perioperative risk, the short- and long-term safety and efficacy of the transapical approach for TAVI therapies. Though at higher perioperative risk, transapically treated patients suffered from less bleeding or vascular complications than transfemorally treated patients. It is of utmost interest that 5-year mortality did not differ between the groups. |
| Audience | Academic |
| Author | Mork, Constantin Gahl, Brigitta Jeger, Raban Reuthebuch, Oliver Eckstein, Friedrich Twerenbold, Raphael Kaiser, Christoph |
| AuthorAffiliation | 1 Department of Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, 4031 Basel, Switzerland 2 Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland 6 Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland 4 Department of Cardiology, University Heart and Vascular Center Hamburg, 20251 Hamburg, Germany 3 University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, 20251 Hamburg, Germany 5 Department of Cardiology, Triemli Hospital Zurich, 8063 Zurich, Switzerland |
| AuthorAffiliation_xml | – name: 3 University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, 20251 Hamburg, Germany – name: 4 Department of Cardiology, University Heart and Vascular Center Hamburg, 20251 Hamburg, Germany – name: 2 Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland – name: 5 Department of Cardiology, Triemli Hospital Zurich, 8063 Zurich, Switzerland – name: 1 Department of Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, 4031 Basel, Switzerland – name: 6 Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland |
| Author_xml | – sequence: 1 givenname: Constantin orcidid: 0000-0001-7928-850X surname: Mork fullname: Mork, Constantin – sequence: 2 givenname: Raphael orcidid: 0000-0003-3814-6542 surname: Twerenbold fullname: Twerenbold, Raphael – sequence: 3 givenname: Brigitta surname: Gahl fullname: Gahl, Brigitta – sequence: 4 givenname: Friedrich surname: Eckstein fullname: Eckstein, Friedrich – sequence: 5 givenname: Raban orcidid: 0000-0003-1290-5491 surname: Jeger fullname: Jeger, Raban – sequence: 6 givenname: Christoph surname: Kaiser fullname: Kaiser, Christoph – sequence: 7 givenname: Oliver orcidid: 0000-0003-1386-0686 surname: Reuthebuch fullname: Reuthebuch, Oliver |
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| Cites_doi | 10.1055/s-0035-1552980 10.1093/ejcts/ezy363 10.1161/CIRCINTERVENTIONS.113.000761 10.1056/NEJMoa1814052 10.4244/EIJV10I8A166 10.1002/sim.6607 10.1016/j.jtcvs.2006.01.026 10.1016/j.jtcvs.2012.09.002 10.1056/NEJMoa1114705 10.1080/00273171.2011.568786 10.1016/j.jtcvs.2018.04.104 10.1016/j.jacc.2003.11.026 10.1161/CIRCULATIONAHA.114.012525 10.1016/j.jcin.2011.03.019 10.4244/EIJ-D-18-01048 10.1093/eurheartj/ehab395 10.1016/j.athoracsur.2013.09.088 10.4244/EIJV8I12A209 10.1111/joic.12084 10.1093/eurheartj/ehx391 10.1161/CIRCULATIONAHA.114.013947 10.1186/s13019-017-0638-9 10.1161/CIRCULATIONAHA.109.907402 10.1161/01.CIR.0000047200.36165.B8 10.1056/NEJMoa1816885 |
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| Keywords | aortic valve replacement mortality transcatheter |
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| SubjectTerms | Aorta Aortic stenosis Aortic valve aortic valve replacement Bioengineering Bleeding Calcification Cardiology Cardiovascular disease Chronic obstructive pulmonary disease Coronary vessels Ethics Heart valves Implantation Interdisciplinary aspects Medical personnel Morbidity Mortality Patients Physiological aspects Prostheses Risk assessment Risk factors Standard deviation Statistical analysis Stenosis Surgeons Survival transcatheter Values Variables Weighting |
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| Title | Similar 5-Year Survival in Transfemoral and Transapical TAVI Patients: A Single-Center Experience |
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