Transapical and transaortic transcatheter aortic valve replacement in the United States

Vinod H. Thourani, Hanna A. Jensen, Vasilis Babaliaros, Rakesh Suri, Sreekanth Vemulapalli, David Dai, J. Matthew Brennan, John Rumsfeld, Fred Edwards, E. Murat Tuzcu, Lars Svensson, Wilson Y. Szeto, Howard Herrmann, Ajay J. Kirtane, Susheel Kodali, David J. Cohen, Stamatios Lerakis, Chandan Devireddy, Eric Sarin, John CarrollDavid Holmes, Frederick L. Grover, Mathew Williams, Hersh Maniar, David Shahian, Michael Mack

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Background When transcatheter aortic valve replacement (TAVR) cannot be carried out through transfemoral access, alternative access TAVR is indicated. The purpose of this study was to explore inhospital and 1-year outcomes of patients undergoing alternative access TAVR through the transapical (TA) or transaortic (TAo) techniques in the United States. Methods Clinical records of 4,953 patients undergoing TA (n = 4,085) or TAo (n = 868) TAVR from 2011 to 2014 in The Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry were linked to Centers for Medicare and Medicaid Services hospital claims. Inhospital and 1-year clinical outcomes were stratified by operative risk; and the risk-adjusted association between access route and mortality, stroke, and heart failure repeat hospitalization was explored. Results Mean age for all patients was 82.8 ± 6.8 years. The median STS predicted risk of mortality was significantly higher among patients undergoing TAo (8.8 versus 7.4, p < 0.001). When compared with TA, TAo was associated with an increased risk of unadjusted 30-day mortality (10.3% versus 8.8%) and 1-year mortality (30.3% versus 25.6%, p = 0.006). There were no significant differences between TAo and TA for inhospital stroke rate (2.2%), major vascular complications (0.3%), and 1-year heart failure rehospitalizations (15.7%). Examination of high-risk and inoperable subgroups showed that 1-year mortality was significantly higher for TAo patients classified as inoperable (p = 0.012). Conclusions Patients undergoing TAo TAVR are older, more likely female, and have significantly higher STS predicted risk of mortality scores than patients operated on by TA access. There were no risk-adjusted differences between TA and TAo access in mortality, stroke, or readmission rates as long as 1 year after TAVR.

Original languageEnglish (US)
Pages (from-to)1718-1727
Number of pages10
JournalAnnals of Thoracic Surgery
Volume100
Issue number5
DOIs
StatePublished - Nov 2015

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Thourani, V. H., Jensen, H. A., Babaliaros, V., Suri, R., Vemulapalli, S., Dai, D., Brennan, J. M., Rumsfeld, J., Edwards, F., Tuzcu, E. M., Svensson, L., Szeto, W. Y., Herrmann, H., Kirtane, A. J., Kodali, S., Cohen, D. J., Lerakis, S., Devireddy, C., Sarin, E., ... Mack, M. (2015). Transapical and transaortic transcatheter aortic valve replacement in the United States. Annals of Thoracic Surgery, 100(5), 1718-1727. https://doi.org/10.1016/j.athoracsur.2015.05.010