TY - JOUR
T1 - The effect of transcatheter aortic valve implantation approaches on mortality
AU - Nijenhuis, Vincent J.
AU - Meyer, Alexander
AU - Brouwer, Jorn
AU - Mahmoodi, Bakhtawar K.
AU - Unbehaun, Axel
AU - Spaziano, Marco
AU - Buzzatti, Nicola
AU - Stundl, Anja
AU - Jørgensen, Troels H.
AU - Kooistra, Nynke H.M.
AU - Adamo, Marianna
AU - Saraf, Smriti
AU - Amrane, Hafid
AU - Bruschi, Giuseppe
AU - Zivelonghi, Carlo
AU - Swaans, Martin J.
AU - Werner, Nikos
AU - Nickenig, Georg
AU - Hildick-Smith, David
AU - Stella, Pieter R.
AU - Latib, Azeem
AU - Soendergaard, Lars
AU - Sinning, Jan Malte
AU - Lefevre, Thierry
AU - Pasic, Miralem
AU - Kempfert, Jorg
AU - ten Berg, Jurrien M.
N1 - Publisher Copyright:
© 2021 Wiley Periodicals LLC.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Objectives: We aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) approaches on mortality and identify effect modifiers and predictors for mortality. Background: 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). Methods: 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. Results: In total, 5,910 patients underwent TAVI via TF (N = 4,072), DA (N = 524), and TA (N = 1,314) access. Compared to TF, 30-day mortality was increased among DA (HR 1.87, 95%CI 1.26–2.78, p =.002) and TA (HR 3.34, 95%CI 2.28–4.89, p <.001) cases. Compared to TF, 5-year mortality was increased among TA cases (HR 1.50, 95%CI 1.24–1.83, p <.001). None of the variables showed a significant interaction between the approaches and mortality. An impaired LVEF (≤35%) increased mortality in all approaches. Conclusions: 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.
AB - Objectives: We aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) approaches on mortality and identify effect modifiers and predictors for mortality. Background: 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). Methods: 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. Results: In total, 5,910 patients underwent TAVI via TF (N = 4,072), DA (N = 524), and TA (N = 1,314) access. Compared to TF, 30-day mortality was increased among DA (HR 1.87, 95%CI 1.26–2.78, p =.002) and TA (HR 3.34, 95%CI 2.28–4.89, p <.001) cases. Compared to TF, 5-year mortality was increased among TA cases (HR 1.50, 95%CI 1.24–1.83, p <.001). None of the variables showed a significant interaction between the approaches and mortality. An impaired LVEF (≤35%) increased mortality in all approaches. Conclusions: 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.
KW - access
KW - left ventricular ejection fraction
KW - propensity
KW - survival
KW - transcatheter aortic valve replacement
KW - transfemoral
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U2 - 10.1002/ccd.29456
DO - 10.1002/ccd.29456
M3 - Article
C2 - 33443813
AN - SCOPUS:85107401983
SN - 1522-1946
VL - 97
SP - 1462
EP - 1469
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 7
ER -