Beyond the learning curve: Transapical versus transfemoral transcatheter aortic valve replacement in the treatment of severe aortic valve stenosis

Kevin L. Greason, Rakesh M. Suri, Vuyisile T Nkomo, Charanjit Rihal, David Holmes, Verghese Mathew

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background Most studies comparing transapical and transfemoral transcatheter aortic valve replacement include the center's early operative experience, which may negatively impact the outcomes. This study reports our experience beyond the learning curve with transapical and transfemoral transcatheter aortic valve replacement. Methods A total of 303 patients underwent transcatheter aortic valve replacement from November 2008 through August 2013. There were 153 patients (50.5%) who received transfemoral valve replacement, 130 (42.9%) received transapical valve replacement, and 20 (6.6%) received transaortic valve replacement. We retrospectively reviewed the outcomes of the most recent 100 consecutive patients each from the transfemoral and transapical valve replacement groups. Results The median age was 82 years (range, 54 to 95) and 110 patients (55%) were male; STS predicted risk of mortality was 8.1% (0.7 to 27.8) and was similar between groups (p = 0.256). Operative complications occurred in 49 patients (49%) in the transapical replacement group and in 43 (43%) in the transfemoral group (p = 0.478). Vascular complications occurred only in the transfemoral group and included nine patients (9%; p = 0.003). Paravalvular regurgitation at discharge of grade mild-moderate occurred in 23 patients (24.2%) in the transapical group in comparison to 40 (43.5%) in the transfemoral group (p = 0.006). Operative mortality occurred in two patients (2%) in the transapical group and in five (5%) in the transfemoral group (p = 0.445). Conclusions Transapical transcatheter aortic valve replacement is associated with less prevalence of vascular complications and mild-moderate paravalvular regurgitation in comparison to the transfemoral approach. Further study is necessary to determine if the transapical technique is the preferred option.

Original languageEnglish (US)
Pages (from-to)303-307
Number of pages5
JournalJournal of Cardiac Surgery
Volume29
Issue number3
DOIs
StatePublished - 2014

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Learning Curve
Aortic Valve Stenosis
Therapeutics
Blood Vessels
Mortality
Transcatheter Aortic Valve Replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Beyond the learning curve : Transapical versus transfemoral transcatheter aortic valve replacement in the treatment of severe aortic valve stenosis. / Greason, Kevin L.; Suri, Rakesh M.; Nkomo, Vuyisile T; Rihal, Charanjit; Holmes, David; Mathew, Verghese.

In: Journal of Cardiac Surgery, Vol. 29, No. 3, 2014, p. 303-307.

Research output: Contribution to journalArticle

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abstract = "Background Most studies comparing transapical and transfemoral transcatheter aortic valve replacement include the center's early operative experience, which may negatively impact the outcomes. This study reports our experience beyond the learning curve with transapical and transfemoral transcatheter aortic valve replacement. Methods A total of 303 patients underwent transcatheter aortic valve replacement from November 2008 through August 2013. There were 153 patients (50.5{\%}) who received transfemoral valve replacement, 130 (42.9{\%}) received transapical valve replacement, and 20 (6.6{\%}) received transaortic valve replacement. We retrospectively reviewed the outcomes of the most recent 100 consecutive patients each from the transfemoral and transapical valve replacement groups. Results The median age was 82 years (range, 54 to 95) and 110 patients (55{\%}) were male; STS predicted risk of mortality was 8.1{\%} (0.7 to 27.8) and was similar between groups (p = 0.256). Operative complications occurred in 49 patients (49{\%}) in the transapical replacement group and in 43 (43{\%}) in the transfemoral group (p = 0.478). Vascular complications occurred only in the transfemoral group and included nine patients (9{\%}; p = 0.003). Paravalvular regurgitation at discharge of grade mild-moderate occurred in 23 patients (24.2{\%}) in the transapical group in comparison to 40 (43.5{\%}) in the transfemoral group (p = 0.006). Operative mortality occurred in two patients (2{\%}) in the transapical group and in five (5{\%}) in the transfemoral group (p = 0.445). Conclusions Transapical transcatheter aortic valve replacement is associated with less prevalence of vascular complications and mild-moderate paravalvular regurgitation in comparison to the transfemoral approach. Further study is necessary to determine if the transapical technique is the preferred option.",
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