Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States.

Published

Journal Article

BACKGROUND: When transcatheter aortic valve replacement (TAVR) cannot be carried out through transfemoral access, alternative access TAVR is indicated. The purpose of this study was to explore inhospital and 1-year outcomes of patients undergoing alternative access TAVR through the transapical (TA) or transaortic (TAo) techniques in the United States. METHODS: Clinical records of 4,953 patients undergoing TA (n = 4,085) or TAo (n = 868) TAVR from 2011 to 2014 in The Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry were linked to Centers for Medicare and Medicaid Services hospital claims. Inhospital and 1-year clinical outcomes were stratified by operative risk; and the risk-adjusted association between access route and mortality, stroke, and heart failure repeat hospitalization was explored. RESULTS: Mean age for all patients was 82.8 ± 6.8 years. The median STS predicted risk of mortality was significantly higher among patients undergoing TAo (8.8 versus 7.4, p < 0.001). When compared with TA, TAo was associated with an increased risk of unadjusted 30-day mortality (10.3% versus 8.8%) and 1-year mortality (30.3% versus 25.6%, p = 0.006). There were no significant differences between TAo and TA for inhospital stroke rate (2.2%), major vascular complications (0.3%), and 1-year heart failure rehospitalizations (15.7%). Examination of high-risk and inoperable subgroups showed that 1-year mortality was significantly higher for TAo patients classified as inoperable (p = 0.012). CONCLUSIONS: Patients undergoing TAo TAVR are older, more likely female, and have significantly higher STS predicted risk of mortality scores than patients operated on by TA access. There were no risk-adjusted differences between TA and TAo access in mortality, stroke, or readmission rates as long as 1 year after TAVR.

Full Text

Duke Authors

Cited Authors

  • Thourani, VH; Jensen, HA; Babaliaros, V; Suri, R; Vemulapalli, S; Dai, D; Brennan, JM; Rumsfeld, J; Edwards, F; Tuzcu, EM; Svensson, L; Szeto, WY; Herrmann, H; Kirtane, AJ; Kodali, S; Cohen, DJ; Lerakis, S; Devireddy, C; Sarin, E; Carroll, J; Holmes, D; Grover, FL; Williams, M; Maniar, H; Shahian, D; Mack, M

Published Date

  • November 2015

Published In

Volume / Issue

  • 100 / 5

Start / End Page

  • 1718 - 1726

PubMed ID

  • 26233276

Pubmed Central ID

  • 26233276

Electronic International Standard Serial Number (EISSN)

  • 1552-6259

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2015.05.010

Language

  • eng

Conference Location

  • Netherlands