Mid-term results of 150 TAVI comparing apical versus femoral approaches

Abstract

BackgroundTranscatheter aortic-valve implantation (TAVI) is a new therapeutic choice for treating aortic stenosis in patients considered high risk for surgery. This blooming therapeutic technique still requires evaluation of medium and long term outcome.MethodWe hereby report our results of the first 150 consecutive patients to receive TAVI implants in our population recruited from July 2009 to March 2013 in a retrospective and monocentric study. We analyzed long term morbidity and mortality criteria. We compared the apical and femoral approach results and researched predictors of cardiac mortality.ResultsThe mean monitoring period was 387.62 days, mean Euroscore was 21.8, and mean Society of Thoracic Surgeons (STS) risk score was 9.2. The success rate for the procedure was 94.6 %. A total of 39 patients died. The mortality rates at the immediate perioperative point, 30 days, 1 year, and 2 years, were 4 %, 11.3 %, 22.7 %, and 26 %, respectively. As regards complications, there were 10 hemodynamic complications (6.6 %) and 20 vascular (13.3 %), 11 cardiac tamponades (7.4 %), eight mechanical (5.3 %), ten major hemorrhagic (6.7 %), 14 pulmonary (9.3 %), and 18 infectious complications (12 %). When comparing the rates of reported complications in terms of different approaches, we observed significantly more hemodynamic complications in the apical group (p = 0.049). Pulmonary complications were also significantly more common in cases of apical approach (p = 0.029). The majority of the patients reported clear functional improvement throughout their follow-up.ConclusionThe results of the first 150 patients to receive the implant at the Nancy University Teaching Hospital (CHU Nancy) were consistent with findings in the literature. TAVI proved a credible and effective alternative to surgical valve replacement for patients at high risk during surgery.

The risk of acute kidney injury following transapical versus transfemoral transcatheter aortic valve replacement: a systematic review and meta-analysis

“…The remaining 158 articles underwent full-length review and 141 of these were excluded for failing to meet criteria (113 articles did not report the outcomes of interest and 28 articles were not observational studies or RCTs). Seventeen cohort studies [ 13 – 28 , 34 ] with 5085 patients were included in the meta-analysis to assess the risk of AKI in patients undergoing TA-TAVR versus TF-TAVR (Table 1 ).…”

“…These studies had a heterogeneous definition of AKI as presented in Table 1 . Most included studies [ 13 – 22 , 24 – 28 , 34 ] used standard AKI definitions [modified Risk, Injury, and Failure; and Loss; and End-stage kidney disease (RIFLE) [ 35 ], Acute Kidney Injury Network (AKIN) [ 36 ] or Kidney Disease: Improving Global Outcomes (KDIGO) criteria [ 37 ]]. AKI was diagnosed 48–72 h following/after a TAVR procedure in most included studies and only six studies [ 13 , 15 , 18 , 24 , 27 , 28 ] identified AKI at 7 days following a TAVR procedure as suggested by Valve Academic Research Consortium-2 (VARC-2) consensus [ 38 ].…”

“…When meta-analysis was limited to the studies using standard AKI definitions, the pooled RR was 2.26 (95% CI 1.75–2.92; I 2 = 53%). We also performed a meta-analysis of studies using VARC-2 consensus [ 13 , 15 , 18 , 24 , 27 , 28 ]. The pooled RR of AKI in patients who underwent TA-TAVR was 2.19 (95% CI 1.37–3.49; I 2 = 44%).…”

“…A few studies have demonstrated higher AKI risk among symptomatic AS patients who underwent TA-TAVR [ 13 – 20 ]. Conversely, several studies have found no significantly greater incidence of AKI in patients who underwent TA-TAVR [ 21 – 28 ].…”

Alternative access routes for transcatheter aortic valve implantation (TAVI

“…Dalším potenciálním úskalím může být brachiální plexus. U některých nemocných leží brachiální plexus proximálně a v bezprostřední blízkosti mý zásah do myokardu levé komory, proto jej většina autorů považuje za nejvíce invazivní a je spojován s vyšším rizikem komplikací a úmrtí [7,24,25]. Vyšší 30denní a roční mortalita je vysvětlována vyšší rizikovostí nemocných, kteří jsou selektováni pro tento přístup, delší výukovou křivkou a menším počtem nemocných.…”