Fröhlich, GM, Baxter, PD, Malkin, CJ et al. (9 more authors) (2015) Comparative Survival after Trans-apical, Direct Aortic, and Subclavian Transcatheter Aortic Valve Implantation (Data from the UK TAVI Registry). American Journal of Cardiology, 116 (10). 1555 - 1559. ISSN 0002-9149
Abstract
Many patients have iliofemoral vessel anatomy unsuitable for conventional transfemoral (TF) transcatheter aortic valve implantation (TAVI). Safe and practical alternatives to the TF approach are, therefore, needed. This study compared outcomes of alternative nonfemoral routes, transapical (TA), direct aortic (DA), and subclavian (SC), with standard femoral access. In this retrospective study, data from 3,962 patients in the UK TAVI registry were analyzed. All patients who received TAVI through a femoral, subclavian, TA, or DA approach were eligible for inclusion. The primary outcome measure was survival up to 2 years. Median Logistic EuroSCORE was similar for SC, DA, and TA but significantly lower in the TF cohort (22.1% vs 20.3% vs 21.2% vs 17.0%, respectively, p <0.0001). Estimated 1-year survival rate was similar for TF (84.6 – 0.7%) and SC (80.5 – 3%, p [ 0.27) but significantly worse for TA (74.7 – 1.6%, p <0.001) and DA (75.2 – 3.3%, p <0.001). A Cox proportional hazard model was used to analyze survival up to 2 years. Survival in the SC group was not significantly different from the TF group (hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.88 to 1.70, p [ 0.24). In contrast, survival in the TA (HR 1.74, 95% CI 1.43 to 2.11; p <0.001) and DA (HR 1.55, 95% CI 1.13 to 2.14; p <0.01) cohorts was significantly reduced compared with TF. In conclusion, TA and DA TAVI were associated with similar survival, both significantly worse than with the TF route. In contrast, subclavian access was not significantly different from TF and may represent the safest nonfemoral access route for TAVI.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2015 Elsevier Inc. This is an author produced version of a paper accepted for publication in American Journal of Cardiology. Uploaded in accordance with the publisher's self-archiving policy. |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Genetics, Health and Therapeutics (LIGHT) > Division of Epidemiology & Biostatistics (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 08 Sep 2015 13:36 |
Last Modified: | 25 Oct 2016 12:26 |
Published Version: | http://dx.doi.org/10.1016/j.amjcard.2015.08.035 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.amjcard.2015.08.035 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:89584 |