Outcomes After Transcatheter Aortic Valve Implantation: Transfemoral Versus Transapical Approach

被引:64
作者
Ewe, See Hooi
Delgado, Victoria
Ng, Arnold C. T.
Antoni, M. Louisa
van der Kley, Frank
Marsan, Nina Ajmone
de Weger, Arend
Tavilla, Giuseppe
Holman, Eduard R.
Schalij, Martin J.
Bax, Jeroen J.
机构
[1] Leiden Univ, Med Ctr, Dept Cardiol & Cardiothorac Surg, NL-2333 ZA Leiden, Netherlands
[2] Natl Heart Ctr, Dept Cardiol, Singapore, Singapore
关键词
LEFT-VENTRICULAR MASS; EUROPEAN-SOCIETY; STENOSIS; RECOMMENDATIONS; REPLACEMENT; GUIDELINES; MANAGEMENT; SEVERITY; DISEASE;
D O I
10.1016/j.athoracsur.2011.01.059
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Transcatheter aortic valve implantation is commonly implanted through a transfemoral (TFA) or transapical approach (TAA) for patients with severe aortic stenosis. This study aimed to describe the clinical and echocardiographic outcomes of TFA versus TAA. Methods. Clinical and echocardiographic evaluations were performed at baseline, post-TAVI (transcatheter aortic valve implantation), at 6 and 12 months follow-up in 107 consecutive patients who underwent TAVI with balloon-expandable valves. Results. The TFA was performed in 44% and the remaining patients underwent TAA. Although procedural complications were not significantly different in both approaches, more vascular complications were observed in the TFA group (18% vs 5%, p = 0.053). Patients with TAA required shorter fluoroscopy time (median 5 vs 12 min, p < 0.001), less contrast volume (median 80 vs 173 mL, p < 0.001), and similar length of hospitalization, as compared with TFA. Importantly, the early 30-day mortality (TFA: 11.1% vs TAA: 8.5%, p = 0.74) were not significantly different between the 2 approaches. Midterm survival at 6 months and 1 year was comparable between TFA and TAA (6 months: 88.9% vs 85.7% and 1 year: 80.2% vs 85.7%). All patients achieved immediate and sustained improvements in transvalvular hemodynamics, together with significant left ventricular mass regression (137 +/- 39 vs 113 +/- 30 g/m(2), p < 001) and left atrial volume reduction (48 +/- 17 vs 34 +/- 14 mL/m(2), p < 0.001) at 6 months or less. Conclusions. Early, midterm, clinical, and echocardiographic outcomes were comparable in both approaches. However, TAA has the additional benefit of reducing radiation exposure and contrast use intraoperatively without prolonging the length of hospital stay. (Ann Thorac Surg 2011;92:1244-51) (C) 2011 by The Society of Thoracic Surgeons
引用
收藏
页码:1244 / 1251
页数:8
相关论文
共 25 条
[1]   Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic value replacement [J].
Bagur, Rodrigo ;
Webb, John G. ;
Nietlispach, Fabian ;
Dumont, Eric ;
De Larochelliere, Robert ;
Doyle, Daniel ;
Masson, Jean-Bernard ;
Gutierrez, Marcos J. ;
Clavel, Marie-Annick ;
Bertrand, Olivier F. ;
Pibarot, Philippe ;
Rodes-Cabau, Josep .
EUROPEAN HEART JOURNAL, 2010, 31 (07) :865-874
[2]   Survival after transapical and transfemoral aortic valve implantation: Talking about two different patient populations [J].
Bleiziffer, Sabine ;
Ruge, Hendrik ;
Mazzitelli, Domenico ;
Hutter, Andrea ;
Opitz, Anke ;
Bauernschmitt, Robert ;
Lange, Ruediger .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2009, 138 (05) :1073-1080
[3]  
Bonow RO, 2008, J AM COLL CARDIOL, V52, pE1, DOI [10.1016/j.hrthm.2008.04.014, 10.1016/j.jacc.2008.05.007]
[4]   Left ventricular mass regression early after aortic valve replacement [J].
Christakis, GT ;
Joyner, CD ;
Morgan, CD ;
Fremes, SE ;
Buth, KJ ;
Sever, JY ;
Rao, V ;
Panagiotopoulos, KP ;
Murphy, PM ;
Goldman, BS .
ANNALS OF THORACIC SURGERY, 1996, 62 (04) :1084-1089
[5]   Comparison of the Hemodynamic Performance of Percutaneous and Surgical Bioprostheses for the Treatment of Severe Aortic Stenosis [J].
Clavel, Marie-Annick ;
Webb, John G. ;
Pibarot, Philippe ;
Altwegg, Lukas ;
Dumont, Eric ;
Thompson, Chris ;
De Larochelliere, Robert ;
Doyle, Daniel ;
Masson, Jean-Bernard ;
Bergeron, Sebastien ;
Bertrand, Olivier F. ;
Rodes-Cabau, Josep .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 53 (20) :1883-1891
[6]  
De Jaegere Peter P Th, 2008, EuroIntervention, V4, P351, DOI 10.4244/EIJV4I3A63
[7]   ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT-VENTRICULAR HYPERTROPHY - COMPARISON TO NECROPSY FINDINGS [J].
DEVEREUX, RB ;
ALONSO, DR ;
LUTAS, EM ;
GOTTLIEB, GJ ;
CAMPO, E ;
SACHS, I ;
REICHEK, N .
AMERICAN JOURNAL OF CARDIOLOGY, 1986, 57 (06) :450-458
[8]   Frailty in older adults: Evidence for a phenotype [J].
Fried, LP ;
Tangen, CM ;
Walston, J ;
Newman, AB ;
Hirsch, C ;
Gottdiener, J ;
Seeman, T ;
Tracy, R ;
Kop, WJ ;
Burke, G ;
McBurnie, MA .
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, 2001, 56 (03) :M146-M156
[9]   Percutaneous aortic valve replacement for severe aortic stenosis in high-rick patients using the second- and current third-generation self-expanding CoreValve prosthesis - Device success and 30-day clinical outcome [J].
Grube, Eberhard ;
Schuler, Gerhard ;
Buellesfeld, Lutz ;
Gerckens, Ulrich ;
Linke, Axel ;
Wenaweser, Peter ;
Sauren, Barthel ;
Mohr, Friedrich-Wilhelm ;
Walther, Thomas ;
Zickmann, Bernfried ;
Iversen, Stein ;
Felderhoff, Thomas ;
Cartier, Raymond ;
Bonan, Raoul .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 50 (01) :69-76
[10]   Results of Transfemoral or Transapical Aortic Valve Implantation Following a Uniform Assessment in High-Risk Patients With Aortic Stenosis [J].
Himbert, Dominique ;
Descoutures, Fleur ;
Al-Attar, Nawwar ;
Iung, Bernard ;
Ducrocq, Gregory ;
Detaint, Delphine ;
Brochet, Eric ;
Messika-Zeitoun, David ;
Francis, Fady ;
Ibrahim, Hassan ;
Nataf, Patrick ;
Vahanian, Alec .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 54 (04) :303-311