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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Bibliographic Details
Published in:Bioengineering (Basel) Vol. 10; no. 2; p. 156
Main Authors: Mork, Constantin, Twerenbold, Raphael, Gahl, Brigitta, Eckstein, Friedrich, Jeger, Raban, Kaiser, Christoph, Reuthebuch, Oliver
Format: Journal Article
Language:English
Published: Switzerland MDPI AG 24.01.2023
MDPI
Subjects:
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
Germany
United States > US
Switzerland
aortic valve replacement
mortality
transcatheter
ISSN:2306-5354, 2306-5354
Online Access:Get full text
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Summary: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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Both authors should be considered as first shared authors.
ISSN:2306-5354
2306-5354
DOI:10.3390/bioengineering10020156