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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Published in:Frontiers in cardiovascular medicine 2023-11, Vol.10, p.1256112-1256112
Main Authors: Maier, Julian, Lambert, Thomas, Senoner, Thomas, Dobner, Stephan, Hoppe, Uta Caroline, Fellner, Alexander, Pfeifer, Bernhard Erich, Feuchtner, Gudrun Maria, Friedrich, Guy, Semsroth, Severin, Bonaros, Nikolaos, Holfeld, Johannes, Müller, Silvana, Reinthaler, Markus, Steinwender, Clemens, Barbieri, Fabian
Format: Article
Language:English
Subjects:
access route
low-flow low-gradient aortic stenosis
transapical access
transcatheter aortic valve implantation
transcatheter aortic valve replacement
transfemoral access
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Summary: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 
ISSN:2297-055X
2297-055X
DOI:10.3389/fcvm.2023.1256112