Non-femoral focused transaxillary access in TAVI: GARY data analysis and future trends.

GARY TAVI Transaortic Transapical Transaxillary Transfemoral Transsubclavian

Journal

Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123

Informations de publication

Date de publication:
04 Mar 2024
Historique:
received: 20 10 2023
accepted: 13 02 2024
medline: 4 3 2024
pubmed: 4 3 2024
entrez: 4 3 2024
Statut: aheadofprint

Résumé

In patients not suitable for transfemoral transcatheter aortic valve implantation (TAVI), several access strategies can be chosen. To evaluate the use and patient outcomes of transaxillary (TAx), transapical (TA), and transaortic (TAo) as alternative access for TAVI in Germany; to further evaluate surgical cutdown vs. percutaneous TAx access. All patients entered the German Aortic Valve Registry (GARY) between 2011 and 2019 who underwent non-transfemoral TAVI were included in this analysis. Patients with TA, TAo, or TAx TAVI were compared using a weighted propensity score model. Furthermore, a subgroup analysis was performed for TAx regarding the percutaneous or surgical cutdown approach. Overall, 9686 patients received a non-transfemoral access. A total of 8918 patients (92.1%) underwent TA, 398 (4.1%) TAo, and 370 (3.8%) TAx approaches. Within the TAx subgroup, 141 patients (38.1%) received subclavian cutdown, while 200 (54.1%) underwent a percutaneous approach. The TA patients had a significantly lower 30-day survival than TAx patients (TA 90.92% vs. TAx 95.59%, p = 0.006; TAo 92.22% vs. TAx 95.59%, p = 0.102). Comparing percutaneous and cutdown TAx approaches, no significant differences were seen. However, more vascular complications occurred (TA 1.8%, TAo 2.4%, TAx 12.2%; p < .001), and the hospital length of stay was shorter (TA 12.9 days, TAo 14.1 days, TAx 12 days; p < .001) after TAx access. It may be reasonable to consider TAx access first in patients not suitable for TF-TAVI, because the 30-day survival was higher compared with TA access and the 1-year survival was higher compared with TAo access. It remains important for the heart teams to offer alternative access modalities for patients not amenable to the standard TF-TAVI approaches.

Sections du résumé

BACKGROUND BACKGROUND
In patients not suitable for transfemoral transcatheter aortic valve implantation (TAVI), several access strategies can be chosen.
AIM OBJECTIVE
To evaluate the use and patient outcomes of transaxillary (TAx), transapical (TA), and transaortic (TAo) as alternative access for TAVI in Germany; to further evaluate surgical cutdown vs. percutaneous TAx access.
METHODS METHODS
All patients entered the German Aortic Valve Registry (GARY) between 2011 and 2019 who underwent non-transfemoral TAVI were included in this analysis. Patients with TA, TAo, or TAx TAVI were compared using a weighted propensity score model. Furthermore, a subgroup analysis was performed for TAx regarding the percutaneous or surgical cutdown approach.
RESULTS RESULTS
Overall, 9686 patients received a non-transfemoral access. A total of 8918 patients (92.1%) underwent TA, 398 (4.1%) TAo, and 370 (3.8%) TAx approaches. Within the TAx subgroup, 141 patients (38.1%) received subclavian cutdown, while 200 (54.1%) underwent a percutaneous approach. The TA patients had a significantly lower 30-day survival than TAx patients (TA 90.92% vs. TAx 95.59%, p = 0.006; TAo 92.22% vs. TAx 95.59%, p = 0.102). Comparing percutaneous and cutdown TAx approaches, no significant differences were seen. However, more vascular complications occurred (TA 1.8%, TAo 2.4%, TAx 12.2%; p < .001), and the hospital length of stay was shorter (TA 12.9 days, TAo 14.1 days, TAx 12 days; p < .001) after TAx access.
CONCLUSION CONCLUSIONS
It may be reasonable to consider TAx access first in patients not suitable for TF-TAVI, because the 30-day survival was higher compared with TA access and the 1-year survival was higher compared with TAo access. It remains important for the heart teams to offer alternative access modalities for patients not amenable to the standard TF-TAVI approaches.

Identifiants

DOI: 10.1007/s00392-024-02402-9 PMID: 38436739
pubmed: 38436739
doi: 10.1007/s00392-024-02402-9
pii: 10.1007/s00392-024-02402-9
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

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Auteurs

Max M Meertens (MM)

Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany. max.meertens@me.com.
ORCID: 0000-0002-7746-8723

Matti Adam (M)

Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany.

Andreas Beckmann (A)

Department of Cardiac and Pediatric Cardiac Surgery, Evanglish Clinical Center Niederrhein, Heart Center Duisburg, Duisburg, Germany.

Stephan Ensminger (S)

Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig Holstein, Lübeck, Germany.
German Center for Cardiovascular Research (DZHK), Partner Sie Hamburg-Kiel-Lübeck, Berlin, Germany.

Christian Frerker (C)

German Center for Cardiovascular Research (DZHK), Partner Sie Hamburg-Kiel-Lübeck, Berlin, Germany.
Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.

Moritz Seiffert (M)

German Center for Cardiovascular Research (DZHK), Partner Sie Hamburg-Kiel-Lübeck, Berlin, Germany.
University Heart and Vascular Center Hamburg, Hamburg, Germany.

Jan-Malte Sinning (JM)

Department of Cardiology, St Vinzenz Hospital, Cologne, Germany.

Raffi Bekeredjian (R)

Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.

Thomas Walther (T)

Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt a. M., Germany.

Friedhelm Beyersdorf (F)

Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.

Helge Möllmann (H)

The Department of Internal Medicine, St.-Johannes-Hospital Dortmund, Dortmund, Germany.

Ümniye Balaban (Ü)

Institute of Biostatistics and Mathematical Modelling, Goethe-University, Frankfurt, Frankfurt a. M., Germany.

Kaveh Eghbalzadeh (K)

Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.

Tanja K Rudolph (TK)

Department for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia Bochum, University Hospital of the Ruhr University, Bad Oeynhausen, Germany.

Sabine Bleiziffer (S)

Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany. sbleiziffer@hdz-nrw.de.

Classifications MeSH