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Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement.

Publication ,  Journal Article
Pineda, AM; Rymer, J; Wang, A; Koweek, LH; Williams, A; Kiefer, T; Wang, A; Gaca, J; Hughes, GC; Harrison, JK
Published in: J Invasive Cardiol
July 2019

BACKGROUND: Alternative access (AA) is still required for a significant proportion of patients undergoing transcatheter aortic valve replacement (TAVR). We sought to compare the clinical outcomes of patients undergoing AA vs transfemoral (TF) access. METHODS: We retrospectively evaluated the outcomes of patients undergoing AA-TAVR between April 2011 and November 2016, and compared them with those who had TF-TAVR. Chi-square and Mann-Whitney U-tests were used to compare the groups and Kaplan-Meier analysis was performed to estimate long-term survival. RESULTS: TAVR was performed in a total of 600 patients, of which 78 (13%) had AA and 522 (87%) had TF access. Patients undergoing AA were younger, and had higher prevalence of chronic obstructive pulmonary disease, peripheral vascular disease, prior myocardial infarction, and prior sternotomy. Greater than mild paravalvular regurgitation (4.2% vs 0.0%; P=.04) and unplanned vascular surgery (5.4% vs 1.3%; P=.09) were more frequent in the TF group. However, patients who underwent AA had longer hospital stay (median 4 days [interquartile range, 3-7 days] vs 3 days [interquartile range, 3-4 days]; P<.001) and an increased incidence of prolonged ventilation (5.1% vs 1.3%; P=.06), 30-day all-cause (5.1% vs 1.7%; P=.08), and cardiovascular mortality (5.1% vs 1.3%; P=.04). The 6-month (15.7% vs 5.7%; P<.01) and 12-month (16.7% vs 10.2%; P=.07) mortality rates were higher for patients undergoing AA. The usage of AA significantly decreased over time (P=.01), primarily driven by a decrease in transapical (P<.001) and direct aortic access (P=.02). CONCLUSIONS: AA-TAVR is associated with an increased incidence of postoperative adverse events, including mortality, when compared with those undergoing TF access.

Duke Scholars

Published In

J Invasive Cardiol

EISSN

1557-2501

Publication Date

July 2019

Volume

31

Issue

7

Start / End Page

E184 / E191

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Male
  • Incidence
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pineda, A. M., Rymer, J., Wang, A., Koweek, L. H., Williams, A., Kiefer, T., … Harrison, J. K. (2019). Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement. J Invasive Cardiol, 31(7), E184–E191.
Pineda, Andrés M., Jennifer Rymer, Alice Wang, Lynne H. Koweek, Adam Williams, Todd Kiefer, Andrew Wang, Jeffrey Gaca, G Chad Hughes, and J Kevin Harrison. “Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement.J Invasive Cardiol 31, no. 7 (July 2019): E184–91.
Pineda AM, Rymer J, Wang A, Koweek LH, Williams A, Kiefer T, et al. Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement. J Invasive Cardiol. 2019 Jul;31(7):E184–91.
Pineda, Andrés M., et al. “Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement.J Invasive Cardiol, vol. 31, no. 7, July 2019, pp. E184–91.
Pineda AM, Rymer J, Wang A, Koweek LH, Williams A, Kiefer T, Gaca J, Hughes GC, Harrison JK. Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement. J Invasive Cardiol. 2019 Jul;31(7):E184–E191.

Published In

J Invasive Cardiol

EISSN

1557-2501

Publication Date

July 2019

Volume

31

Issue

7

Start / End Page

E184 / E191

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Male
  • Incidence