Key result
Transapical TAVI in patients with LVEF ≤35% had similar 30-day mortality to transfemoral TAVI (11.6% vs 7.9%, P=0.45) but higher overall mortality at follow-up (OR 2.577, P=0.006).
Why the study?
Does transapical TAVI compared to transfemoral TAVI affect mortality in patients with LVEF ≤35%?
Cohort (n=208)
Yes
Does transapical TAVI compared to transfemoral TAVI affect mortality in patients with LVEF ≤35%?
Answers are grounded in this paper and cite their sources.
Transapical TAVI was associated with higher long-term mortality in LVEF ≤35% patients; leaves open whether access route independently affects outcomes.
OBJECTIVES: The most commonly used accesses for transcatheter aortic valve implantation (TAVI) are the transfemoral (TF-TAVI) and the transapical (TA-TAVI) ones. There are concerns about TA-TAVI use in patients with reduced left ventricular ejection fraction (LVEF). The aim of this retrospective multicentre study was to compare the outcomes of TA-TAVI and TF-TAVI in patients with poor LVEF. METHODS: Patients with LVEF ≤35% were included in the analysis. Data were obtained from the Italian Transcatheter Balloon-Expandable Registry (ITER), which enrolled patients undergoing TAVI with the Sapien bioprosthesis in 33 national centres. Patients were divided into 2 groups according to the access: TA or TF. A multivariable logistic regression analysis was performed in order to evaluate whether the type of approach (TA and TF) has an impact on outcomes. RESULTS: Between 2007 and 2012, 1882 patients were enrolled in the Registry. LVEF ≤35% was found in 208 (11.1%) patients. TA-TAVI and TF-TAVI were performed in 69 (33.2%) and 139 (66.8%) patients, respectively. Overall 30-day mortality was 11.6% and 7.9% in TA and TF patients, respectively (P = 0.45). Overall Kaplan-Meier survival was significantly higher in the TF-TAVI group (log rank: P = 0.003). Age [odds ratio (OR) 1.066, P = 0.016], creatinine (OR: 2.301, P < 0.001), preoperative permanent pacemaker (OR: 4.662, P = 0.035) and TA approach (OR: 2.577, P = 0.006) were identified as independent predictors of overall mortality at follow-up. However, the TA approach resulted an independent variable of mortality only 3 years after TAVI. CONCLUSIONS: TAVI yields good results in patients with depressed LVEF. Age, preoperative creatinine and preoperative pacemaker are independently associated with mortality. The TA access is associated with mortality only after 3 years of follow-up, thus probably reflecting a worse general clinical status of these patients.
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D’Onofrio et al. (2017) conducted a cohort in Aortic valve disease with poor left ventricular ejection fraction (n=208). Transapical transcatheter aortic valve implantation (TA-TAVI) vs. Transfemoral transcatheter aortic valve implantation (TF-TAVI) was evaluated on Overall 30-day mortality (p=0.45). Transapical TAVI in patients with LVEF ≤35% had similar 30-day mortality to transfemoral TAVI (11.6% vs 7.9%, P=0.45) but higher overall mortality at follow-up (OR 2.577, P=0.006).
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