Mortality risk similar with different TAVR approaches
medwireNews: Rates of 30-day mortality and 1-year survival are similar among patients undergoing transcatheter aortic valve replacement (TAVR) with a transfemoral (TF), transaortic (TAo), and transapical (TA) approach, study results suggest.
In a retrospective analysis, Thierry Lefèvre (Institut Cardiovasculaire Paris Sud, Massy, France) and colleagues found that 5% of 467 patients undergoing TAVR with a TF approach died within 30 days, compared with 9% of 289 patients in the TAo group, and 14% of 42 patients in the TA group, with no significant differences observed between groups.
Additionally, the authors found that rates of cumulative 1-year survival were not significantly different between the three groups, with corresponding rates of approximately 90%, 80%, and 70%.
“Although the 30-day mortality and 1-year survival rates were similar in TF and TAo TAVR patients, we observed a trend in favor of the TF approach,” write the study authors in JACC: Cardiovascular Interventions.
There was no significant difference in the rates of procedural success or major stroke between the three groups, but acute kidney injury was significantly more common with TAo versus TF and with TA versus TAo, with rates of 13%, 5%, and 31% for TAo, TF, and TA, respectively.
In an accompanying editorial comment, Peter Block (Emory University Hospital, Atlanta, Georgia, USA) and Michael Mack (The Heart Hospital Baylor Plano, Texas, USA) say that “[b]y 2015, of the approximately 32,000 TAVR procedures performed in the United States, 90% were performed by a TF approach with the remaining 10% equally divided between TA and transaortic (TAo) approaches.”
Although the study authors found a trend in favor of the TF approach, “not every patient with aortic stenosis can have a TF/TAVR,” the commentators add, explaining that “the iliofemoral arteries may be too small, too diseased (even for the current smaller devices), too tortuous, or too calcified (especially if the calcification is circumferential).”
They believe that “[f]or heart teams deciding which strategy is best for their patients who cannot have a TF/TAVR”, the study results “indicate that TAo/TAVR is a valid alternative to TA/TAVR.”
When comparing the TAo and TA groups, the authors note that although not significant, the cumulative 1-year survival rate “tended to be higher” in the TAo group.
Although the study included a limited number of patients from a single center and the mean follow-up was only 199 days, meaning that long-term multicenter studies are required to validate the findings, the research team concludes that “it seems reasonable that the TF approach should still be the primary choice when anatomically feasible, because of its lesser invasiveness compared with the TAo approach.”
And they add: “However, the TAo approach can be considered as an alternative to the TA approach when TF TAVR is unsuitable.”
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