What question did this study set out to answer?

To compare clinical outcomes across different vascular access approaches in patients undergoing transcatheter aortic valve implantation with a self-expandable bioprosthesis.

February 13, 2015Journal of Cardiovascular Medicine

Role of different vascular approaches on transcatheter aortic valve implantation outcome

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Transcatheter aortic valve implantation (TAVI) (n=322). Intervention: Vascular approach (transaxillary and transaortic) vs. Transfemoral approach (percutaneous and cut-down). Primary outcome: Clinical outcomes according to Valve Academic Research Consortium-2 recommendations.

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Key result

Transaortic and transaxillary approaches for CoreValve implantation yielded similar clinical outcomes to transfemoral approaches, but transaortic had higher device success (88.6% vs 65.9%; P=0.019).

Why the study?

Do alternative vascular approaches (cTF, TAx, TAo) compared to the percutaneous transfemoral approach affect clinical outcomes in patients undergoing TAVI?

Key Points

To compare clinical outcomes across different vascular access approaches in patients undergoing transcatheter aortic valve implantation with a self-expandable bioprosthesis.
Single-center cohort study evaluating N=322 consecutive patients undergoing CoreValve implantation between September 2007 and March 2014.
Patients were categorized into four vascular approach groups: percutaneous transfemoral (n=170, 53%), cut-down transfemoral (n=76, 23%), transaxillary (n=32, 10%), and transaortic (n=44, 14%).
Clinical outcomes and endpoints were assessed according to Valve Academic Research Consortium-2 criteria through 2 years of follow-up.
Observed device success was higher in the transaortic group at 88.6%, compared with 65.9% in percutaneous transfemoral, 68.7% in cut-down transfemoral, and 76.3% in transaxillary approaches (P = 0.019).
No significant differences occurred across the four groups in cardiovascular and all-cause mortality at 30 days, 1 year, and 2 years, or in rates of stroke, myocardial infarction, major bleeding, and acute kidney injury.
Atrial fibrillation and prosthetic valve regurgitation independently predicted all-cause mortality, whereas vascular access route was not an independent predictor.

Study Design

Type

Cohort (n=322)

Multicenter

Structured PICO

Do alternative vascular approaches (cTF, TAx, TAo) compared to the percutaneous transfemoral approach affect clinical outcomes in patients undergoing TAVI?

Population

322 consecutive patients undergoing CoreValve implantation evaluated for clinical outcomes based on vascular approach over 2 years.

Exposure

Alternative vascular approaches for TAVI: cut-down transfemoral (cTF, n=76), transaxillary (TAx, n=32), or transaortic (TAo, n=44)

Comparator

Percutaneous transfemoral (pTF, n=170) approach

Outcome

Clinical outcomes evaluated according to Valve Academic Research Consortium-2 (VARC-2) recommendations (including cardiovascular and all-cause mortality, stroke, myocardial infarction, bleeding, major vascular complications, permanent pacemaker implantation, and acute kidney injury) at 30 days, 1 and 2 yearscomposite

Alternative, more invasive vascular approaches for TAVI yield similar early to long-term clinical outcomes compared to the percutaneous transfemoral approach, even in higher-risk patients.

Discussion

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Implication

Alternative access routes may yield comparable TAVI outcomes in observational data; leaves open optimal strategy and device success in randomized trials.

Cite This Study

Adamo et al. (2015) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=322). Vascular approach (transaxillary and transaortic) vs. Transfemoral approach (percutaneous and cut-down) was evaluated on Clinical outcomes according to Valve Academic Research Consortium-2 recommendations. Transaortic and transaxillary approaches for CoreValve implantation yielded similar clinical outcomes to transfemoral approaches, but transaortic had higher device success (88.6% vs 65.9%; P=0.019).

synapsesocial.com/papers/6a9b1718388090d12d91cafb https://doi.org/10.2459/jcm.0000000000000252

Topics

Transcatheter aortic valve replacement TAVR in low-risk patients Atrial fibrillation Persistent AF management AF ablation outcomes

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Implication

Alternative access routes may yield comparable TAVI outcomes in observational data; leaves open optimal strategy and device success in randomized trials.

Role of different vascular approaches on transcatheter aortic valve implantation outcome

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Topics

Role of different vascular approaches on transcatheter aortic valve implantation outcome

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider