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Nijenhuis, Vincent J.; Meyer, Alexander; Brouwer, Jorn; Mahmoodi, Bakhtawar K.; Unbehaun, Axel; Spaziano, Marco; Buzzatti, Nicola; Stundl, Anja; Jørgensen, Troels H.; Kooistra, Nynke H.M.; Adamo, Marianna; Saraf, Smriti; Amrane, Hafid; Bruschi, Giuseppe; Zivelonghi, Carlo; Swaans, Martin J.; Werner, Nikos; Nickenig, Georg; Hildick‐Smith, David; Stella, Pieter R.; Latib, Azeem; Soendergaard, Lars; Sinning, Jan‐Malte; Lefevre, Thierry; [...]

The effect of transcatheter aortic valve implantation approaches on mortality

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  • Media type: E-Article
  • Title: The effect of transcatheter aortic valve implantation approaches on mortality
  • Contributor: Nijenhuis, Vincent J.; Meyer, Alexander; Brouwer, Jorn; Mahmoodi, Bakhtawar K.; Unbehaun, Axel; Spaziano, Marco; Buzzatti, Nicola; Stundl, Anja; Jørgensen, Troels H.; Kooistra, Nynke H.M.; Adamo, Marianna; Saraf, Smriti; Amrane, Hafid; Bruschi, Giuseppe; Zivelonghi, Carlo; Swaans, Martin J.; Werner, Nikos; Nickenig, Georg; Hildick‐Smith, David; Stella, Pieter R.; Latib, Azeem; Soendergaard, Lars; Sinning, Jan‐Malte; Lefevre, Thierry; [...]
  • imprint: Wiley, 2021
  • Published in: Catheterization and Cardiovascular Interventions
  • Language: English
  • DOI: 10.1002/ccd.29456
  • ISSN: 1522-1946; 1522-726X
  • Keywords: Cardiology and Cardiovascular Medicine ; Radiology, Nuclear Medicine and imaging ; General Medicine
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>We aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) approaches on mortality and identify effect modifiers and predictors for mortality.</jats:p></jats:sec><jats:sec><jats:title>Background</jats:title><jats:p>Alternative access routes to transfemoral (TF) TAVI include the surgical intra‐thoracic direct‐aortic (DA) and transapical (TA) approach. TA TAVI has been associated with a higher mortality rate. We hypothesized that this is related to effect modifiers, in particular the left ventricular ejection fraction (LVEF).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This multicentre study derived its data from prospective registries. To adjust for confounders, we used propensity‐score based, stabilized inverse probability weighted Cox regression models.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In total, 5,910 patients underwent TAVI via TF (<jats:italic>N</jats:italic> = 4,072), DA (<jats:italic>N</jats:italic> = 524), and TA (<jats:italic>N</jats:italic> = 1,314) access. Compared to TF, 30‐day mortality was increased among DA (HR 1.87, 95%CI 1.26–2.78, <jats:italic>p</jats:italic> = .002) and TA (HR 3.34, 95%CI 2.28–4.89, <jats:italic>p</jats:italic> &lt; .001) cases. Compared to TF, 5‐year mortality was increased among TA cases (HR 1.50, 95%CI 1.24–1.83, <jats:italic>p</jats:italic> &lt; .001). None of the variables showed a significant interaction between the approaches and mortality. An impaired LVEF (≤35%) increased mortality in all approaches.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The surgical intra‐thoracic TA and DA TAVI are both associated with a higher 30‐day mortality than TF TAVI. TA TAVI is associated with a higher 5‐year mortality than TF TAVI. The DA approach may therefore have some advantages over the TA approach when TF access is not feasible.</jats:p></jats:sec>