Abstract | OBJECTIVES: METHODS: We retrospectively analyzed the clinical outcome of 121 consecutive patients undergoing transapical (N = 50) or transfemoral (N = 71) Edwards Sapien transcatheter aortic valve replacement. Routinely, no preimplant balloon valvuloplasty was performed in transapical procedure as opposed to uniform preimplant balloon valvuloplasty in transfemoral cases. The incidence and severity of total and paravalvular aortic regurgitation and 30-day clinical outcomes were compared between the 2 cohorts. RESULTS: The average patient's age was 84.4 years, with a higher prevalence of smoking history (68% vs 42%, P = .005) and peripheral vascular disease (38% vs 20%, P = .03) in the patients undergoing transapical replacement. The preprocedural transthoracic echocardiographic and computed tomography findings were similar between the 2 cohorts. After transcatheter aortic valve replacement, the incidence of mild to moderate total aortic regurgitation (42% transfemoral vs 38% transapical), paravalvular aortic regurgitation (39% transfemoral vs 30% transapical), device success (88.7% transfemoral vs 94.0% transapical), and 30-day composite end points (9.9% transfemoral vs 14.0% transapical) were comparable in both groups. Multivariate regression analysis revealed male gender (odds ratio, 2.7; 95% confidence interval, 1.18-6.35; P = .02) but not preimplant balloon valvuloplasty as an independent predictor for mild or greater total aortic regurgitation. CONCLUSIONS:
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Authors | S Chiu Wong, Sumeet Pawar, Robert M Minutello, Evelyn M Horn, Nikolaos J Skubas, Richard B Devereux, Arash Salemi |
Journal | The Journal of thoracic and cardiovascular surgery
(J Thorac Cardiovasc Surg)
Vol. 150
Issue 5
Pg. 1111-7
(Nov 2015)
ISSN: 1097-685X [Electronic] United States |
PMID | 26277463
(Publication Type: Comparative Study, Journal Article)
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Copyright | Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Aged, 80 and over
- Aortic Valve
(physiopathology)
- Aortic Valve Insufficiency
(diagnosis, etiology)
- Aortic Valve Stenosis
(diagnosis, physiopathology, surgery)
- Balloon Valvuloplasty
(adverse effects)
- Cardiac Catheterization
(adverse effects, instrumentation, methods)
- Chi-Square Distribution
- Female
- Heart Valve Prosthesis
- Heart Valve Prosthesis Implantation
(adverse effects, instrumentation, methods)
- Humans
- Logistic Models
- Male
- Multivariate Analysis
- Odds Ratio
- Prosthesis Design
- Retrospective Studies
- Risk Factors
- Severity of Illness Index
- Time Factors
- Treatment Outcome
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