Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement
IntroductionPrevious analyses have reported the outcomes of transcatheter aortic valve replacement (TAVR) for patients with low-flow, low-gradient (LFLG) aortic stenosis (AS), without stratifying according to the route of access. Differences in mortality rates among access routes have been establish...
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1256112/full |
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| author | Julian Maier Julian Maier Julian Maier Julian Maier Thomas Lambert Thomas Lambert Thomas Senoner Stephan Dobner Stephan Dobner Uta Caroline Hoppe Alexander Fellner Alexander Fellner Bernhard Erich Pfeifer Bernhard Erich Pfeifer Gudrun Maria Feuchtner Guy Friedrich Severin Semsroth Nikolaos Bonaros Johannes Holfeld Silvana Müller Markus Reinthaler Markus Reinthaler Clemens Steinwender Clemens Steinwender Clemens Steinwender Fabian Barbieri Fabian Barbieri |
| author_facet | Julian Maier Julian Maier Julian Maier Julian Maier Thomas Lambert Thomas Lambert Thomas Senoner Stephan Dobner Stephan Dobner Uta Caroline Hoppe Alexander Fellner Alexander Fellner Bernhard Erich Pfeifer Bernhard Erich Pfeifer Gudrun Maria Feuchtner Guy Friedrich Severin Semsroth Nikolaos Bonaros Johannes Holfeld Silvana Müller Markus Reinthaler Markus Reinthaler Clemens Steinwender Clemens Steinwender Clemens Steinwender Fabian Barbieri Fabian Barbieri |
| author_sort | Julian Maier |
| collection | DOAJ |
| description | IntroductionPrevious analyses have reported the outcomes of transcatheter aortic valve replacement (TAVR) for patients with low-flow, low-gradient (LFLG) aortic stenosis (AS), without stratifying according to the route of access. Differences in mortality rates among access routes have been established for high-gradient (HG) patients and hypothesized to be even more pronounced in LFLG AS patients. This study aims to compare the outcomes of patients with LFLG or HG AS following transfemoral (TF) or transapical (TA) TAVR.MethodsA total of 910 patients, who underwent either TF or TA TAVR with a median follow-up of 2.22 (IQR: 1.22–4.03) years, were included in this multicenter cohort study. In total, 146 patients (16.04%) suffered from LFLG AS. The patients with HG and LFLG AS were stratified according to the route of access and compared statistically.ResultsThe operative mortality rates of patients with HG and LFLG were found to be comparable following TF access. The operative mortality rate was significantly increased for patients who underwent TA access [odds ratio (OR): 2.91 (1.54–5.48), p = 0.001] and patients with LFLG AS [OR: 2.27 (1.13–4.56), p = 0.02], which could be corroborated in a propensity score-matched subanalysis. The observed increase in the risk of operative mortality demonstrated an additive effect [OR for TA LFLG: 5.45 (2.35–12.62), p < 0.001]. LFLG patients who underwent TA access had significantly higher operative mortality rates (17.78%) compared with TF LFLG (3.96%, p = 0.016) and TA HG patients (6.36%, p = 0.024).ConclusionsHG patients experienced a twofold increase in operative mortality rates following TA compared with TF access, while LFLG patients had a fivefold increase in operative mortality rates. TA TAVR appears suboptimal for patients with LFLG AS. Prospective studies should be conducted to evaluate alternative options in cases where TF is not possible. |
| first_indexed | 2024-03-11T10:58:17Z |
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| last_indexed | 2024-03-11T10:58:17Z |
| publishDate | 2023-11-01 |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-79fae0e7d147425fb583525a44381c452023-11-13T03:45:19ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-11-011010.3389/fcvm.2023.12561121256112Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacementJulian Maier0Julian Maier1Julian Maier2Julian Maier3Thomas Lambert4Thomas Lambert5Thomas Senoner6Stephan Dobner7Stephan Dobner8Uta Caroline Hoppe9Alexander Fellner10Alexander Fellner11Bernhard Erich Pfeifer12Bernhard Erich Pfeifer13Gudrun Maria Feuchtner14Guy Friedrich15Severin Semsroth16Nikolaos Bonaros17Johannes Holfeld18Silvana Müller19Markus Reinthaler20Markus Reinthaler21Clemens Steinwender22Clemens Steinwender23Clemens Steinwender24Fabian Barbieri25Fabian Barbieri26Department of Cardiology, Kepler University Hospital, Linz, AustriaJohannes Kepler University Linz, Medical Faculty, Linz, AustriaInstitute for Cardiovascular and Metabolic Research (ICMR), Johannes Kepler University Linz, Linz, AustriaInstitute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, AustriaDepartment of Cardiology, Kepler University Hospital, Linz, AustriaJohannes Kepler University Linz, Medical Faculty, Linz, AustriaUniversity Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, AustriaDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland3rd Medical Department of Cardiology and Intensive Care Medicine, Clinic Ottakring (former Wilhelminenhospital), Vienna, AustriaUniversity Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, AustriaDepartment of Cardiology, Kepler University Hospital, Linz, AustriaJohannes Kepler University Linz, Medical Faculty, Linz, AustriaInstitute of Clinical Epidemiology, Tirol Kliniken, Innsbruck, Austria0Division of Digital Medicine and Telehealth, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria1Department of Radiology, Medical University Innsbruck, Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria2Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria2Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria2Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria3Department of Cardiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany4Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, Teltow, GermanyDepartment of Cardiology, Kepler University Hospital, Linz, AustriaJohannes Kepler University Linz, Medical Faculty, Linz, AustriaInstitute for Cardiovascular and Metabolic Research (ICMR), Johannes Kepler University Linz, Linz, AustriaUniversity Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria3Department of Cardiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyIntroductionPrevious analyses have reported the outcomes of transcatheter aortic valve replacement (TAVR) for patients with low-flow, low-gradient (LFLG) aortic stenosis (AS), without stratifying according to the route of access. Differences in mortality rates among access routes have been established for high-gradient (HG) patients and hypothesized to be even more pronounced in LFLG AS patients. This study aims to compare the outcomes of patients with LFLG or HG AS following transfemoral (TF) or transapical (TA) TAVR.MethodsA total of 910 patients, who underwent either TF or TA TAVR with a median follow-up of 2.22 (IQR: 1.22–4.03) years, were included in this multicenter cohort study. In total, 146 patients (16.04%) suffered from LFLG AS. The patients with HG and LFLG AS were stratified according to the route of access and compared statistically.ResultsThe operative mortality rates of patients with HG and LFLG were found to be comparable following TF access. The operative mortality rate was significantly increased for patients who underwent TA access [odds ratio (OR): 2.91 (1.54–5.48), p = 0.001] and patients with LFLG AS [OR: 2.27 (1.13–4.56), p = 0.02], which could be corroborated in a propensity score-matched subanalysis. The observed increase in the risk of operative mortality demonstrated an additive effect [OR for TA LFLG: 5.45 (2.35–12.62), p < 0.001]. LFLG patients who underwent TA access had significantly higher operative mortality rates (17.78%) compared with TF LFLG (3.96%, p = 0.016) and TA HG patients (6.36%, p = 0.024).ConclusionsHG patients experienced a twofold increase in operative mortality rates following TA compared with TF access, while LFLG patients had a fivefold increase in operative mortality rates. TA TAVR appears suboptimal for patients with LFLG AS. Prospective studies should be conducted to evaluate alternative options in cases where TF is not possible.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1256112/fulllow-flow low-gradient aortic stenosistranscatheter aortic valve implantationtranscatheter aortic valve replacementaccess routetransapical accesstransfemoral access |
| spellingShingle | Julian Maier Julian Maier Julian Maier Julian Maier Thomas Lambert Thomas Lambert Thomas Senoner Stephan Dobner Stephan Dobner Uta Caroline Hoppe Alexander Fellner Alexander Fellner Bernhard Erich Pfeifer Bernhard Erich Pfeifer Gudrun Maria Feuchtner Guy Friedrich Severin Semsroth Nikolaos Bonaros Johannes Holfeld Silvana Müller Markus Reinthaler Markus Reinthaler Clemens Steinwender Clemens Steinwender Clemens Steinwender Fabian Barbieri Fabian Barbieri Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement Frontiers in Cardiovascular Medicine low-flow low-gradient aortic stenosis transcatheter aortic valve implantation transcatheter aortic valve replacement access route transapical access transfemoral access |
| title | Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement |
| title_full | Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement |
| title_fullStr | Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement |
| title_full_unstemmed | Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement |
| title_short | Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement |
| title_sort | impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement |
| topic | low-flow low-gradient aortic stenosis transcatheter aortic valve implantation transcatheter aortic valve replacement access route transapical access transfemoral access |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1256112/full |
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