Long-term outcomes associated with the transaortic approach to transcatheter Aortic valve replacement

Joel A. Lardizabal, Conrad J. MacOn, Brian P. O'Neill, Harit Desai, Vikas Singh, Claudia Martinez, Carlos E Alfonso, Mauricio G Cohen, Alan W. Heldman, William W. O'Neill, Donald Williams

Research output: Contribution to journalArticle

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Abstract

Objective We investigated the long-term safety, efficacy and clinical outcomes associated with transaortic (TAO) transcatheter aortic valve replacement (TAVR) in the United States. Background We previously reported the technical feasibility and short-term safety of TAO TAVR. Compared to transapical (TAP) access, the TAO approach was associated with shorter median intensive care unit (ICU) length of stay (LOS) and more favorable technical learning curve. However, outcomes data beyond 30 days were lacking and the longer-term clinical consequences of this strategy were unknown. Methods Mortality outcomes at 1 year (and longer) of 44 consecutive patients who underwent TAO TAVR in our institution were compared with that of 76 consecutive patients who underwent TAP TAVR at our site. Risk-adjusted analysis was performed in propensity-matched patients (25 from each group) to account for baseline differences. Results TAO TAVR was associated with a trend towards lower all-cause mortality at 1 year compared to TAP TAVR (18% vs. 34%, P=0.09 in the overall sample; 12% vs. 40%, P=0.05 in the matched cohort). The higher probability of survival with TAO TAVR persisted after a median follow-up period of 23 months (hazard ratio [HR]=1.96, P=0.06 in the overall sample; HR=3.4, P=0.01 in the matched cohort). Cardiovascular mortality at 1 year was lower with TAO TAVR (2% vs. 22%, P=0.01 in the overall sample; 4% vs. 28%, P=0.05 in the matched cohort). ICU LOS (shorter in the TAO group) and implantation of second prosthetic valve (higher incidence in the TAP group) were independent predictors of long-term mortality. Conclusion The outcomes associated with TAO TAVR compare favorably with TAP TAVR. Our results appear to corroborate the long-term safety and efficacy of the TAO approach in TAVR patients with inadequate iliofemoral access.

Original languageEnglish (US)
Pages (from-to)1226-1230
Number of pages5
JournalCatheterization and Cardiovascular Interventions
Volume85
Issue number7
DOIs
StatePublished - Jun 1 2015

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Mortality
Safety
Intensive Care Units
Length of Stay
Transcatheter Aortic Valve Replacement
Learning Curve
Survival
Incidence

Keywords

  • Aortic Stenosis
  • Heart Valve Surgery
  • Interventional Cardiology
  • Structural Heart Disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Long-term outcomes associated with the transaortic approach to transcatheter Aortic valve replacement. / Lardizabal, Joel A.; MacOn, Conrad J.; O'Neill, Brian P.; Desai, Harit; Singh, Vikas; Martinez, Claudia; Alfonso, Carlos E; Cohen, Mauricio G; Heldman, Alan W.; O'Neill, William W.; Williams, Donald.

In: Catheterization and Cardiovascular Interventions, Vol. 85, No. 7, 01.06.2015, p. 1226-1230.

Research output: Contribution to journalArticle

Lardizabal, Joel A. ; MacOn, Conrad J. ; O'Neill, Brian P. ; Desai, Harit ; Singh, Vikas ; Martinez, Claudia ; Alfonso, Carlos E ; Cohen, Mauricio G ; Heldman, Alan W. ; O'Neill, William W. ; Williams, Donald. / Long-term outcomes associated with the transaortic approach to transcatheter Aortic valve replacement. In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 85, No. 7. pp. 1226-1230.
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abstract = "Objective We investigated the long-term safety, efficacy and clinical outcomes associated with transaortic (TAO) transcatheter aortic valve replacement (TAVR) in the United States. Background We previously reported the technical feasibility and short-term safety of TAO TAVR. Compared to transapical (TAP) access, the TAO approach was associated with shorter median intensive care unit (ICU) length of stay (LOS) and more favorable technical learning curve. However, outcomes data beyond 30 days were lacking and the longer-term clinical consequences of this strategy were unknown. Methods Mortality outcomes at 1 year (and longer) of 44 consecutive patients who underwent TAO TAVR in our institution were compared with that of 76 consecutive patients who underwent TAP TAVR at our site. Risk-adjusted analysis was performed in propensity-matched patients (25 from each group) to account for baseline differences. Results TAO TAVR was associated with a trend towards lower all-cause mortality at 1 year compared to TAP TAVR (18{\%} vs. 34{\%}, P=0.09 in the overall sample; 12{\%} vs. 40{\%}, P=0.05 in the matched cohort). The higher probability of survival with TAO TAVR persisted after a median follow-up period of 23 months (hazard ratio [HR]=1.96, P=0.06 in the overall sample; HR=3.4, P=0.01 in the matched cohort). Cardiovascular mortality at 1 year was lower with TAO TAVR (2{\%} vs. 22{\%}, P=0.01 in the overall sample; 4{\%} vs. 28{\%}, P=0.05 in the matched cohort). ICU LOS (shorter in the TAO group) and implantation of second prosthetic valve (higher incidence in the TAP group) were independent predictors of long-term mortality. Conclusion The outcomes associated with TAO TAVR compare favorably with TAP TAVR. Our results appear to corroborate the long-term safety and efficacy of the TAO approach in TAVR patients with inadequate iliofemoral access.",
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T1 - Long-term outcomes associated with the transaortic approach to transcatheter Aortic valve replacement

AU - Lardizabal, Joel A.

AU - MacOn, Conrad J.

AU - O'Neill, Brian P.

AU - Desai, Harit

AU - Singh, Vikas

AU - Martinez, Claudia

AU - Alfonso, Carlos E

AU - Cohen, Mauricio G

AU - Heldman, Alan W.

AU - O'Neill, William W.

AU - Williams, Donald

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Objective We investigated the long-term safety, efficacy and clinical outcomes associated with transaortic (TAO) transcatheter aortic valve replacement (TAVR) in the United States. Background We previously reported the technical feasibility and short-term safety of TAO TAVR. Compared to transapical (TAP) access, the TAO approach was associated with shorter median intensive care unit (ICU) length of stay (LOS) and more favorable technical learning curve. However, outcomes data beyond 30 days were lacking and the longer-term clinical consequences of this strategy were unknown. Methods Mortality outcomes at 1 year (and longer) of 44 consecutive patients who underwent TAO TAVR in our institution were compared with that of 76 consecutive patients who underwent TAP TAVR at our site. Risk-adjusted analysis was performed in propensity-matched patients (25 from each group) to account for baseline differences. Results TAO TAVR was associated with a trend towards lower all-cause mortality at 1 year compared to TAP TAVR (18% vs. 34%, P=0.09 in the overall sample; 12% vs. 40%, P=0.05 in the matched cohort). The higher probability of survival with TAO TAVR persisted after a median follow-up period of 23 months (hazard ratio [HR]=1.96, P=0.06 in the overall sample; HR=3.4, P=0.01 in the matched cohort). Cardiovascular mortality at 1 year was lower with TAO TAVR (2% vs. 22%, P=0.01 in the overall sample; 4% vs. 28%, P=0.05 in the matched cohort). ICU LOS (shorter in the TAO group) and implantation of second prosthetic valve (higher incidence in the TAP group) were independent predictors of long-term mortality. Conclusion The outcomes associated with TAO TAVR compare favorably with TAP TAVR. Our results appear to corroborate the long-term safety and efficacy of the TAO approach in TAVR patients with inadequate iliofemoral access.

AB - Objective We investigated the long-term safety, efficacy and clinical outcomes associated with transaortic (TAO) transcatheter aortic valve replacement (TAVR) in the United States. Background We previously reported the technical feasibility and short-term safety of TAO TAVR. Compared to transapical (TAP) access, the TAO approach was associated with shorter median intensive care unit (ICU) length of stay (LOS) and more favorable technical learning curve. However, outcomes data beyond 30 days were lacking and the longer-term clinical consequences of this strategy were unknown. Methods Mortality outcomes at 1 year (and longer) of 44 consecutive patients who underwent TAO TAVR in our institution were compared with that of 76 consecutive patients who underwent TAP TAVR at our site. Risk-adjusted analysis was performed in propensity-matched patients (25 from each group) to account for baseline differences. Results TAO TAVR was associated with a trend towards lower all-cause mortality at 1 year compared to TAP TAVR (18% vs. 34%, P=0.09 in the overall sample; 12% vs. 40%, P=0.05 in the matched cohort). The higher probability of survival with TAO TAVR persisted after a median follow-up period of 23 months (hazard ratio [HR]=1.96, P=0.06 in the overall sample; HR=3.4, P=0.01 in the matched cohort). Cardiovascular mortality at 1 year was lower with TAO TAVR (2% vs. 22%, P=0.01 in the overall sample; 4% vs. 28%, P=0.05 in the matched cohort). ICU LOS (shorter in the TAO group) and implantation of second prosthetic valve (higher incidence in the TAP group) were independent predictors of long-term mortality. Conclusion The outcomes associated with TAO TAVR compare favorably with TAP TAVR. Our results appear to corroborate the long-term safety and efficacy of the TAO approach in TAVR patients with inadequate iliofemoral access.

KW - Aortic Stenosis

KW - Heart Valve Surgery

KW - Interventional Cardiology

KW - Structural Heart Disease

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