PDF herunterladen
Thorac Cardiovasc Surg 2016; 64(05): 374-381
DOI: 10.1055/s-0035-1555606
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Transfemoral versus Transapical Aortic Implantation for Aortic Stenosis Based on No Significant Difference in Logistic EuroSCORE: A Meta-Analysis

Zhifang Liu
1   Department of Cardiovascular Surgery, Zhejiang Hospital, Hangzhou, People's Republic of China
,
Renliang He
1   Department of Cardiovascular Surgery, Zhejiang Hospital, Hangzhou, People's Republic of China
,
Canghao Wu
1   Department of Cardiovascular Surgery, Zhejiang Hospital, Hangzhou, People's Republic of China
,
Yu Xia
1   Department of Cardiovascular Surgery, Zhejiang Hospital, Hangzhou, People's Republic of China
› Institutsangaben
Weitere Informationen

Publikationsverlauf

07. August 2014

18. Mai 2015

Publikationsdatum:
29. Juni 2015 (online)

    Lizenzen und Reprints Alle Artikel dieser Rubrik

Abstract

Background Transcatheter aortic valve implantation (TAVI) has gained increasing acceptance for patients with severe aortic stenosis (AS). The present meta-analysis was performed to assess if the transapical (TA) approach has any benefit in reduction of mortality and complications relative to the transfemoral (TF) approach for patients with AS.

Methods All relevant studies comparing TF-TAVI and TA-TAVI from January 2002 to November 2013 were retrieved from Medline and Embase databases. The relative risk (RR) and 95% confidence interval (CI) were used to evaluate the difference between two groups. Heterogeneity assumption was assessed by an I 2 test. The random-effect model or fixed-effect model was used to estimate summary effect based on I 2 test.

Results Nine studies conformed to the predefined criteria, including 666 patients in the TF-TAVI group and 457 patients in the TA-TAVI group. No difference was found in all-cause mortality at 30 days and beyond 1 year between the two groups (30 days: 9.2% versus 11.4%; RR, 0.72; 95% CI, 0.47 to 1.11; p = 0.14 and beyond 1 year: RR, 0.96; 95% CI, 0.59 to 1.56; p = 0.86). There was a trend toward increased incidence of stroke in patients in the TF-TAVI group (4.7% versus 2.6%; RR, 1.64; 95% CI, 0.75 to 3.58; p = 0.21), and the incidence of vascular complication and postoperative heart block were significantly increased in patients having TF-TAVI (vascular complications: 14.7% versus 7.1%; RR, 2.04; 95% CI, 1.15 to 3.61; p = 0.01 and heart block: 13.4% versus 4.6%; RR, 2.53; 95% CI, 1.10 to 5.83; p = 0.03). Additionally, more patients in the TF-TAVI group required permanent pacemaker relative to the TA-TAVI group (10.8% versus 3.4%; RR, 2.74; 95% CI, 1.41 to 5.32; p = 0.003).

Conclusions Among patients with AS with no significant difference in logistic EuroSCORE, TA-TAVI has a lower risk of vascular complication and postoperative heart block but a similar incidence of stroke and mortality compared with TF-TAVI. Accordingly, TA approach is a promising and feasible option for the patients with severe AS.

Keywords

transcatheter aortic valve implantation - transfemoral - transapical - aortic stenosis - meta-analysis
 

  • References

  • 1 Cribier A, Eltchaninoff H, Bash A , et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 2002; 106 (24) 3006-3008
    CrossrefPubMedGoogle Scholar
  • 2 Kapadia SR, Goel SS, Svensson L , et al. Characterization and outcome of patients with severe symptomatic aortic stenosis referred for percutaneous aortic valve replacement. J Thorac Cardiovasc Surg 2009; 137 (6) 1430-1435
    CrossrefPubMedGoogle Scholar
  • 3 Webb JG, Pasupati S, Humphries K , et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation 2007; 116 (7) 755-763
    CrossrefPubMedGoogle Scholar
  • 4 Di Mario C, Eltchaninoff H, Moat N , et al; Transcatheter Valve Treatment Sentinel Registry (TCVT) Investigators of the EURObservational Research Programme (EORP) of the European Society of Cardiology. The 2011–12 pilot European Sentinel Registry of Transcatheter Aortic Valve Implantation: in-hospital results in 4,571 patients. EuroIntervention 2013; 8 (12) 1362-1371
    CrossrefPubMedGoogle Scholar
  • 5 Gilard M, Eltchaninoff H, Iung B , et al; FRANCE 2 Investigators. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med 2012; 366 (18) 1705-1715
    CrossrefPubMedGoogle Scholar
  • 6 Karalis DG, Quinn V, Victor MF , et al. Risk of catheter-related emboli in patients with atherosclerotic debris in the thoracic aorta. Am Heart J 1996; 131 (6) 1149-1155
    CrossrefPubMedGoogle Scholar
  • 7 Nombela-Franco L, Rodés-Cabau J, Doyle D , et al. Transaortic transcatheter aortic valve implantation: potential issues associated with the use of the ASCENDRA transapical delivery system. J Card Surg 2012; 27 (4) 438-440
    CrossrefPubMedGoogle Scholar
  • 8 Rodés-Cabau J, Gutiérrez M, Bagur R , et al. Incidence, predictive factors, and prognostic value of myocardial injury following uncomplicated transcatheter aortic valve implantation. J Am Coll Cardiol 2011; 57 (20) 1988-1999
    CrossrefPubMedGoogle Scholar
  • 9 Thomas M, Schymik G, Walther T , et al. One-year outcomes of cohort 1 in the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry: the European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 2011; 124 (4) 425-433
    CrossrefPubMedGoogle Scholar
  • 10 Dworakowski R, MacCarthy PA, Monaghan M , et al. Transcatheter aortic valve implantation for severe aortic stenosis-a new paradigm for multidisciplinary intervention: a prospective cohort study. Am Heart J 2010; 160 (2) 237-243
    CrossrefPubMedGoogle Scholar
  • 11 Bleiziffer S, Ruge H, Mazzitelli D , et al. Survival after transapical and transfemoral aortic valve implantation: talking about two different patient populations. J Thorac Cardiovasc Surg 2009; 138 (5) 1073-1080
    CrossrefPubMedGoogle Scholar
  • 12 Eltchaninoff H, Prat A, Gilard M , et al; FRANCE Registry Investigators. Transcatheter aortic valve implantation: early results of the FRANCE (FRench Aortic National CoreValve and Edwards) registry. Eur Heart J 2011; 32 (2) 191-197
    CrossrefPubMedGoogle Scholar
  • 13 Ewe SH, Delgado V, Ng AC , et al. Outcomes after transcatheter aortic valve implantation: transfemoral versus transapical approach. Ann Thorac Surg 2011; 92 (4) 1244-1251
    CrossrefPubMedGoogle Scholar
  • 14 Guinot PG, Depoix JP, Etchegoyen L , et al. Anesthesia and perioperative management of patients undergoing transcatheter aortic valve implantation: analysis of 90 consecutive patients with focus on perioperative complications. J Cardiothorac Vasc Anesth 2010; 24 (5) 752-761
    CrossrefPubMedGoogle Scholar
  • 15 Himbert D, Descoutures F, Al-Attar N , et al. Results of transfemoral or transapical aortic valve implantation following a uniform assessment in high-risk patients with aortic stenosis. J Am Coll Cardiol 2009; 54 (4) 303-311
    CrossrefPubMedGoogle Scholar
  • 16 Nielsen HH, Thuesen L, Egeblad H , et al. Single center experience with transcatheter aortic valve implantation using the Edwards SAPIEN™ Valve. Scand Cardiovasc J 2011; 45 (5) 261-266
    CrossrefPubMedGoogle Scholar
  • 17 Puls M, Viel T, Danner BC , et al. The risk-to-benefit ratio of transcatheter aortic valve implantation in specific patient cohorts: a single-centre experience. Clin Res Cardiol 2012; 101 (7) 553-563
    CrossrefPubMedGoogle Scholar
  • 18 Spargias K, Polymeros S, Dimopoulos A , et al. The predictive value and evolution of N-terminal pro-B-type natriuretic peptide levels following transcutaneous aortic valve implantation. J Interv Cardiol 2011; 24 (5) 462-469
    CrossrefPubMedGoogle Scholar
  • 19 Zhao QM, Lognone T, Ivascau C , et al. Procedural results and 30-day clinical events analysis following Edwards transcatheter aortic valve implantation in 48 consecutive patients: initial experience. Chin Med J (Engl) 2012; 125 (16) 2807-2810
    PubMedGoogle Scholar
  • 20 Grossi EA, Schwartz CF, Yu PJ , et al. High-risk aortic valve replacement: are the outcomes as bad as predicted?. Ann Thorac Surg 2008; 85 (1) 102-106 , discussion 107
    CrossrefPubMedGoogle Scholar
  • 21 Leontyev S, Walther T, Borger MA , et al. Aortic valve replacement in octogenarians: utility of risk stratification with EuroSCORE. Ann Thorac Surg 2009; 87 (5) 1440-1445
    CrossrefPubMedGoogle Scholar
  • 22 Kempfert J, Rastan A, Holzhey D , et al. Transapical aortic valve implantation: analysis of risk factors and learning experience in 299 patients. Circulation 2011; 124 (11, Suppl): S124-S129
    CrossrefPubMedGoogle Scholar
  • 23 Schymik G, Schröfel H, Schymik JS , et al. Acute and late outcomes of Transcatheter Aortic Valve Implantation (TAVI) for the treatment of severe symptomatic aortic stenosis in patients at high- and low-surgical risk. J Interv Cardiol 2012; 25 (4) 364-374
    CrossrefPubMedGoogle Scholar
  • 24 Li X, Kong M, Jiang D, Dong A. Comparison 30-day clinical complications between transfemoral versus transapical aortic valve replacement for aortic stenosis: a meta-analysis review. J Cardiothorac Surg 2013; 8: 168
    CrossrefPubMedGoogle Scholar
  • 25 Kodali SK, Williams MR, Smith CR , et al; PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366 (18) 1686-1695
    CrossrefPubMedGoogle Scholar
  • 26 Piazza N, Grube E, Gerckens U , et al. Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention 2008; 4 (2) 242-249
    CrossrefPubMedGoogle Scholar
  • 27 Svensson LG, Dewey T, Kapadia S , et al. United States feasibility study of transcatheter insertion of a stented aortic valve by the left ventricular apex. Ann Thorac Surg 2008; 86 (1) 46-54 , discussion 54–55
    CrossrefPubMedGoogle Scholar
  • 28 Walther T, Falk V, Kempfert J , et al. Transapical minimally invasive aortic valve implantation; the initial 50 patients. Eur J Cardiothorac Surg 2008; 33 (6) 983-988
    CrossrefPubMedGoogle Scholar
  • 29 Webb JG, Altwegg L, Boone RH , et al. Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes. Circulation 2009; 119 (23) 3009-3016
    CrossrefPubMedGoogle Scholar
  • 30 Grube E, Schuler G, Buellesfeld L , et al. Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome. J Am Coll Cardiol 2007; 50 (1) 69-76
    CrossrefPubMedGoogle Scholar
  • 31 Webb JG. Percutaneous aortic valve replacement will become a common treatment for aortic valve disease. JACC Cardiovasc Interv 2008; 1 (2) 122-126
    CrossrefPubMedGoogle Scholar
  • 32 Masson J-B, Kovac J, Schuler G , et al. Transcatheter aortic valve implantation: review of the nature, management, and avoidance of procedural complications. JACC Cardiovasc Interv 2009; 2 (9) 811-820
    CrossrefPubMedGoogle Scholar
  • 33 Eggebrecht H, Schmermund A, Voigtländer T, Kahlert P, Erbel R, Mehta RH. Risk of stroke after transcatheter aortic valve implantation (TAVI): a meta-analysis of 10,037 published patients. EuroIntervention 2012; 8 (1) 129-138
    CrossrefPubMedGoogle Scholar
  • 34 Eltchaninoff H, Zajarias A, Tron C , et al. Transcatheter aortic valve implantation: technical aspects, results and indications. Arch Cardiovasc Dis 2008; 101 (2) 126-132
    CrossrefPubMedGoogle Scholar
  • 35 Bosmans JM, Kefer J, De Bruyne B , et al; Belgian TAVI Registry Participants. Procedural, 30-day and one year outcome following CoreValve or Edwards transcatheter aortic valve implantation: results of the Belgian national registry. Interact Cardiovasc Thorac Surg 2011; 12 (5) 762-767
    CrossrefPubMedGoogle Scholar
  • 36 Walther T, Thielmann M, Kempfert J , et al. PREVAIL TRANSAPICAL: multicentre trial of transcatheter aortic valve implantation using the newly designed bioprosthesis (SAPIEN-XT) and delivery system (ASCENDRA-II). Eur J Cardiothorac Surg 2012; 42 (2) 278-283 , discussion 283
    CrossrefPubMedGoogle Scholar