Key result
The transapical approach for transcatheter aortic valve implantation was associated with significantly higher in-hospital mortality (9% vs 4%, p=0.002) and more complications per patient compared to the transfemoral approach.
Why the study?
Does transapical TAVI compared to transfemoral TAVI increase perioperative complications in patients undergoing the procedure under general anaesthesia?
Cohort (n=853)
No
Does transapical TAVI compared to transfemoral TAVI increase perioperative complications in patients undergoing the procedure under general anaesthesia?
Absolute Event Rate: 9% vs 4%
p-value: p=0.002
Transapical TAVI is associated with higher perioperative morbidity and in-hospital mortality compared to transfemoral TAVI, largely reflecting the higher baseline risk profile of patients selected for the transapical approach.
Should not yet alter access site selection given observational design; leaves open whether excess risk is independent of patient factors.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat degenerative heart valve disease. The implantation requires a highly specific and interdisciplinary management approach. Currently, TAVI is performed with the patient under local or general anaesthesia. METHODS: This study was a retrospective analysis of all TAVI procedures performed at the University Hospital of Regensburg between January 2009 and July 2015. All pre-, intra and postoperative data focusing on perioperative complications were recorded. RESULTS: A total of 853 transfemoral- and transapical-TAVI patients were included in the study. All patients underwent general anaesthesia. The ASA classifications were primarily 3-4. The average logistic EuroScores for the transfemoral- and transapical-TAVI patients were 18 ± 12% and 21 ± 15% (p = 0.002), respectively. The anaesthesia coverage time was 170 ± 49 min., including 37 ± 12 minutes for anaesthetic management. Overall, 458 complications were recorded; with pneumonia, acute renal failure, indication for a permanent pacemaker and non-extubation in the operating theatre the most frequently recorded complications. CONCLUSION: In the present study, we showed that our patients' outcomes are comparable to those reported in the available literature. Compared to TF, TA patients show an overall worse physical condition as well as a higher perioperative morbidity and mortality. Consequently TA patients need additional care and should only be operated in appropriately experienced medical centres.
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Würschinger et al. (2018) conducted a cohort in Aortic valve stenosis (n=853). Transapical (TA) approach vs. Transfemoral (TF) approach was evaluated on In-hospital mortality (p=0.002). The transapical approach for transcatheter aortic valve implantation was associated with significantly higher in-hospital mortality (9% vs 4%, p=0.002) and more complications per patient compared to the transfemoral approach.
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