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Propensity-Matched Comparisons of Clinical Outcomes After Transapical or Transfemoral Transcatheter Aortic Valve Replacement: A Placement of Aortic Transcatheter Valves (PARTNER)-I Trial Substudy

Blackstone, Eugene H. et al.

Circulation: journal of the American Heart Association. Volume 131:Issue 22 (2015, June 2nd) -- Lippincott Williams & Wilkins -- Highwire Press

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  • Title:
    Propensity-Matched Comparisons of Clinical Outcomes After Transapical or Transfemoral Transcatheter Aortic Valve Replacement: A Placement of Aortic Transcatheter Valves (PARTNER)-I Trial Substudy
  • Author: Blackstone, Eugene H.;
    Suri, Rakesh M.;
    Rajeswaran, Jeevanantham;
    Babaliaros, Vasilis;
    Douglas, Pamela S.;
    Fearon, William F.;
    Miller, D. Craig;
    Hahn, Rebecca T.;
    Kapadia, Samir;
    Kirtane, Ajay J.;
    Kodali, Susheel K.;
    Mack, Michael;
    Szeto, Wilson Y.;
    Thourani, Vinod H.;
    Tuzcu, E. Murat;
    Williams, Mathew R.;
    Akin, Jodi J.;
    Leon, Martin B.;
    Svensson, Lars G.
  • Found In: Circulation: journal of the American Heart Association. Volume 131:Issue 22 (2015, June 2nd)
  • Journal Title: Circulation: journal of the American Heart Association
  • Subjects: Blood Circulation; Cardiovascular System; Vascular Diseases; Blood--Circulation--Periodicals; Cardiology--Periodicals; Cardiovascular system--Periodicals; Heart--Diseases--Periodicals; aortic valve insufficiency--mortality--propensity score--stroke--transcatheter aortic valve replacement; Dewey: 616.1
  • Rights: legaldeposit
  • Publication Details: Lippincott Williams & Wilkins
    Highwire Press
  • Abstract: Abstract : Background—:

    The higher risk of adverse outcomes after transapical (TA) versus transfemoral (TF) transcatheter aortic valve replacement (TAVR) could be attributable to TA-TAVR being an open surgical procedure or to clinical differences between TA- and TF-TAVR patients. We compared outcomes after neutralizing patient differences using propensity score matching.

    Methods and Results—:

    From April 2007 to February 2012, 1100 Placement of Aortic Transcatheter Valves (PARTNER)-I patients underwent TA-TAVR and 1521 underwent TF-TAVR with Edwards SAPIEN balloon-expandable bioprostheses. Propensity matching based on 111 preprocedural variables, exclusive of femoral access morphology, identified 501 well-matched patient pairs (46% of possible matches), 95% of whom had peripheral arterial disease. Matched TA-TAVR patients experienced more adverse procedural events, longer length of stay (5 versus 8 days; P <0.0001), and slower recovery (New York Heart Association class I, 31% versus 38% at 30 days, equalizing by 6 months at 51% versus 47%); stroke risk was similar (3.4% versus 3.3% at 30 days and 6.0% versus 6.7% at 3 years); mortality was elevated for the first 6 postprocedural months (19% versus 12%; P =0.01); but aortic regurgitation was less (34% versus 52% mild and 8.9% versus 12% moderate to severe at discharge, P =0.001; 36% versus 50% mild and 10% versus 15% moderate to severe at 6 months, P <0.0001).

    Conclusions—:

    The likelihood of adverse periprocedural events and prolonged recovery is greater after TA-TAVR than TF-TAVR in vasculopathic patients after accounting for differences in cardiovascular risk factors, although stroke risk is equivalent and aortic regurgitation is less. As smaller delivery systems permit TF-TAVR in many of these patients, we recommend a TF-first access strategy for TAVR when anatomically feasible.

    Clinical Trial Registration—:

    URL:http://www.clinicaltrials.gov. Unique identifier: NCT00530894.

    Abstract :

    Supplemental Digital Content is available in the text.


  • Identifier: System Number: LDEAvdc_100052067723.0x000001; Journal ISSN: 0009-7322; 10.1161/CIRCULATIONAHA.114.012525
  • Publication Date: 2015
  • Physical Description: Electronic
  • Shelfmark(s): ELD Digital store

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