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van Wely M, van Nieuwkerk AC, Rooijakkers M, van der Wulp K, Gehlmann H, Verkroost M, van Garsse L, Geuzebroek G, Baz JA, Tchétché D, De Brito FS, Barbanti M, Kornowski R, Latib A, D'Onofrio A, Ribichini F, Dangas G, Mehran R, Delewi R, van Royen N. Transaxillary versus transfemoral access as default access in TAVI: A propensity matched analysis. Int J Cardiol 2024; 394:131353. [PMID: 37696359 DOI: 10.1016/j.ijcard.2023.131353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/10/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Transfemoral (TF) access is default in transcatheter aortic valve implantation (TAVI). Transaxillary (TAx) access has been shown to be a safe alternative in case of prohibitive iliofemoral anatomy, but whether TAx as preferred access has similar safety and efficacy as TF access is unknown. The aim of this study was to compare outcomes between patients treated with self-expanding devices using TF or TAx route as preferred access in TAVI. METHODS A single center cohort of 354 patients treated using TAx as preferred access and a multi-center cohort of 5980 patients treated using TF access were compared. Propensity score matching was used to reduce selection bias and potential confounding. After propensity score matching, each group consisted of 322 patients. Clinical outcomes according to VARC-2 were compared using chi-square test. RESULTS In 6334 patients undergoing TAVI, mean age was 81.4 ± 7.0 years, 57% was female and median logistic EuroSCORE was 14.7% (IQR 9.5-22.6). In the matched population (age 79.3 ± 7.0, 50% female, logistic EuroSCORE 13.4%, IQR 9.0-21.5), primary outcomes 30-day and one-year all-cause mortality were similar between Tax and TF groups (30 days: 5% versus 6%, p = 0.90; 1 year: 20% versus 16%, p = 0.17). Myocardial infarction was more frequent in patients undergoing Tax TAVI compared with TF (4% versus 1%, p = 0.05), but new permanent pacemakers were less frequently implanted (12% versus 21%, p = 0.001). CONCLUSION TAx as preferred access is feasible and safe with outcomes that are comparable to TF access.
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Affiliation(s)
- Marleen van Wely
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Astrid C van Nieuwkerk
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Maxim Rooijakkers
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Kees van der Wulp
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Helmut Gehlmann
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Michel Verkroost
- Department of Cardio-Thoracic surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Leen van Garsse
- Department of Cardio-Thoracic surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Guillaume Geuzebroek
- Department of Cardio-Thoracic surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - José Antonio Baz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | | | - Fabio S De Brito
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy.
| | - Ran Kornowski
- Rabin Medical Center, Cardiology Department, Petach Tikva, Israel.
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Montefiore Medical Center, Department of Interventional Cardiology, New York, USA.
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Ronak Delewi
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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Rooijakkers M, van Wely M, Stens N, Gehlmann H, van Garsse L, Geuzebroek G, Verkroost M, van Royen N. TCT-469 Using the Brachial Vein as Temporary Pacemaker Access Site: A Next Step in Minimizing Invasiveness of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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van Wely M, van der Wulp K, Rooijakkers M, Vart P, Morshuis W, van Royen N, Gehlmann H, Verkroost M, Kievit P, van Garsse L, Geuzebroek G. Aortic Regurgitation Index Ratio Is a Strong Predictor of 1-Year Mortality After Transcatheter Aortic Valve Implantation Using Self-Expanding Devices. Semin Thorac Cardiovasc Surg 2020; 33:923-930. [DOI: 10.1053/j.semtcvs.2020.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022]
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Philip S, Chen E, Hutchison S, O'Gara P, Missov E, Hughes GC, Gilon D, Conklin L, Shalhub S, Khoynezhad A, Bekeredjian R, Montgomery D, Geuzebroek G, Taylor B, Tolva V, Isselbacher E, Nienaber C, Eagle K. NEW MURMUR OF AORTIC INSUFFICIENCY IN ACUTE AORTIC DISSECTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32731-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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