Mid-Term Outcomes after Transapical and Transfemoral Transcatheter Aortic Valve Implantation for Aortic Stenosis and Porcelain Aorta with a Systematic Review of Transfemoral versus Transapical Approach

Dritan Useini; Peter Haldenwang; Markus Schlömicher; Hildegard Christ; Hamid Naraghi; Vadim Moustafine; Justus Strauch

doi:10.1055/s-0039-1692719

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2020; 68(07): 623-632
DOI: 10.1055/s-0039-1692719

Original Cardiovascular

Mid-Term Outcomes after Transapical and Transfemoral Transcatheter Aortic Valve Implantation for Aortic Stenosis and Porcelain Aorta with a Systematic Review of Transfemoral versus Transapical Approach

Dritan Useini

¹Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany

,

Peter Haldenwang

¹Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany

,

Markus Schlömicher

¹Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany

,

Hildegard Christ

²Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany

,

Hamid Naraghi

¹Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany

,

Vadim Moustafine

¹Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany

,

Justus Strauch

¹Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany

› Author Affiliations

Abstract

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Abstract

Background We have aimed to analyze early and mid-term outcomes of patients undergoing transapical/transfemoral transcatheter aortic valve implantation (TA-/TF-TAVI) for aortic stenosis and porcelain aorta (PAo) in our institution. Additionally, we postulated that the TA approach may be associated with a more favorable neurological outcome than the TF approach; hence, a systematic literature review was conducted.

Methods Between 2011 and 2017, 15 patients with PAo underwent TA-TAVI and 4 patients with PAo TF-TAVI at our institution. The assessment of PAo was done either intraoperatively after aborted sternotomy or via computed tomography for elective TAVI. We conducted mid-term follow-up. Furthermore, a systematic review was performed to compare the mortality and neurological outcomes of TF and TA-TAVI approaches.

Results TA/TF-TAVIs were performed with 100% device success, without paravalvular leakage ≥ 2 and without procedural death. The 30-day mortality/stroke rates were 6.6%/0% in TA-TAVI and 0%/25% in TF-TAVI, respectively. The 6-month, 1-year, and 2-year survival rates were in TA/TF-TAVI 93%/75%, 82%/66.6%, and 50%/0%, respectively.

The pooled results derived from the literature review were as follows: The prevalence of PAo in the TAVI population is 9.74%; the mean logistic EuroSCORE is 41.9% in TA-TAVI versus 16.2% in TF-TAVI; the mean 30-day mortality is 5.9% in TA-TAVI versus 6.3% in TF-TAVI, and the mean stroke is 0.8% in TA-TAVI versus 9% in TF-TAVI.

Conclusion TA-TAVI shows promising early and mid-term outcomes in patients with PAo. TF-TAVI performed in patients with PAo is likely to be associated with higher rates of stroke than TA-TAVI.

Keywords

heart valves - transapical - percutaneous (TAVI) - aorta/aortic - stroke

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References

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