Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States
Background When transcatheter aortic valve replacement (TAVR) cannot be carried out through transfemoral access, alternative access TAVR is indicated. The purpose of this study was to explore inhospital and 1-year outcomes of patients undergoing alternative access TAVR through the transapical (TA) o...
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| creator | Thourani, Vinod H., MD Jensen, Hanna A., MD, PhD Babaliaros, Vasilis, MD Suri, Rakesh, MD, DPhil Vemulapalli, Sreekanth, MD Dai, David, PhD, MS Brennan, J. Matthew, MD Rumsfeld, John, MD, PhD Edwards, Fred, MD Tuzcu, E. Murat, MD Svensson, Lars, MD, PhD Szeto, Wilson Y., MD Herrmann, Howard, MD Kirtane, Ajay J., MD, SM Kodali, Susheel, MD Cohen, David J., MD Lerakis, Stamatios, MD Devireddy, Chandan, MD Sarin, Eric, MD Carroll, John, MD Holmes, David, MD Grover, Frederick L., MD Williams, Mathew, MD Maniar, Hersh, MD Shahian, David, MD Mack, Michael, MD |
| description | Background When transcatheter aortic valve replacement (TAVR) cannot be carried out through transfemoral access, alternative access TAVR is indicated. The purpose of this study was to explore inhospital and 1-year outcomes of patients undergoing alternative access TAVR through the transapical (TA) or transaortic (TAo) techniques in the United States. Methods Clinical records of 4,953 patients undergoing TA (n = 4,085) or TAo (n = 868) TAVR from 2011 to 2014 in The Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry were linked to Centers for Medicare and Medicaid Services hospital claims. Inhospital and 1-year clinical outcomes were stratified by operative risk; and the risk-adjusted association between access route and mortality, stroke, and heart failure repeat hospitalization was explored. Results Mean age for all patients was 82.8 ± 6.8 years. The median STS predicted risk of mortality was significantly higher among patients undergoing TAo (8.8 versus 7.4, p < 0.001). When compared with TA, TAo was associated with an increased risk of unadjusted 30-day mortality (10.3% versus 8.8%) and 1-year mortality (30.3% versus 25.6%, p = 0.006). There were no significant differences between TAo and TA for inhospital stroke rate (2.2%), major vascular complications (0.3%), and 1-year heart failure rehospitalizations (15.7%). Examination of high-risk and inoperable subgroups showed that 1-year mortality was significantly higher for TAo patients classified as inoperable ( p = 0.012). Conclusions Patients undergoing TAo TAVR are older, more likely female, and have significantly higher STS predicted risk of mortality scores than patients operated on by TA access. There were no risk-adjusted differences between TA and TAo access in mortality, stroke, or readmission rates as long as 1 year after TAVR. |
| doi_str_mv | 10.1016/j.athoracsur.2015.05.010 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1729352515</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0003497515008310</els_id><sourcerecordid>1729352515</sourcerecordid><originalsourceid>FETCH-LOGICAL-c499t-8882a3320a9c89bbf9efeb95607f233b66233d4113b29531aebad7ef53c83ab83</originalsourceid><addsrcrecordid>eNqNUU1P3DAQtSpQ2dL-hcpHLtn6Y53EFyRA0CIhIfHRHq2JMxFess5iO0j773EUChInpJHsGb-ZN36PEMrZkjNe_lovIT0MAWwcw1IwrpYsB2dfyIIrJYpSKL1HFowxWax0pQ7ItxjXORX5-Ss5EKWQUlTlgvy7C-AjbJ2FnoJv6ZwPITk7322mwoSBnszFv9A_I73BbQ8WN-gTdZ5mCL33LmFLbxMkjN_Jfgd9xB-v5yG5vzi_O_tTXF3_vjw7uSrsSutU1HUtIK_CQNtaN02nscNGq5JVXV6xKadF2xXnshFaSQ7YQFthp6StJTS1PCRH89xtGJ5GjMlsXLTY9-BxGKPhldBSCcVVhtYz1IYhxoCd2Qa3gbAznJlJVrM277KaSVbDcnCWW3--sozNBtu3xv86ZsDpDMD812eHwUTr0FtsXUCbTDu4z7Acfxhie-cnZx5xh3E9jMFnLQ03URhmbid7J3e5YqyWecALhxajnw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1729352515</pqid></control><display><type>article</type><title>Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Thourani, Vinod H., MD ; Jensen, Hanna A., MD, PhD ; Babaliaros, Vasilis, MD ; Suri, Rakesh, MD, DPhil ; Vemulapalli, Sreekanth, MD ; Dai, David, PhD, MS ; Brennan, J. Matthew, MD ; Rumsfeld, John, MD, PhD ; Edwards, Fred, MD ; Tuzcu, E. Murat, MD ; Svensson, Lars, MD, PhD ; Szeto, Wilson Y., MD ; Herrmann, Howard, MD ; Kirtane, Ajay J., MD, SM ; Kodali, Susheel, MD ; Cohen, David J., MD ; Lerakis, Stamatios, MD ; Devireddy, Chandan, MD ; Sarin, Eric, MD ; Carroll, John, MD ; Holmes, David, MD ; Grover, Frederick L., MD ; Williams, Mathew, MD ; Maniar, Hersh, MD ; Shahian, David, MD ; Mack, Michael, MD</creator><creatorcontrib>Thourani, Vinod H., MD ; Jensen, Hanna A., MD, PhD ; Babaliaros, Vasilis, MD ; Suri, Rakesh, MD, DPhil ; Vemulapalli, Sreekanth, MD ; Dai, David, PhD, MS ; Brennan, J. Matthew, MD ; Rumsfeld, John, MD, PhD ; Edwards, Fred, MD ; Tuzcu, E. Murat, MD ; Svensson, Lars, MD, PhD ; Szeto, Wilson Y., MD ; Herrmann, Howard, MD ; Kirtane, Ajay J., MD, SM ; Kodali, Susheel, MD ; Cohen, David J., MD ; Lerakis, Stamatios, MD ; Devireddy, Chandan, MD ; Sarin, Eric, MD ; Carroll, John, MD ; Holmes, David, MD ; Grover, Frederick L., MD ; Williams, Mathew, MD ; Maniar, Hersh, MD ; Shahian, David, MD ; Mack, Michael, MD</creatorcontrib><description>Background When transcatheter aortic valve replacement (TAVR) cannot be carried out through transfemoral access, alternative access TAVR is indicated. The purpose of this study was to explore inhospital and 1-year outcomes of patients undergoing alternative access TAVR through the transapical (TA) or transaortic (TAo) techniques in the United States. Methods Clinical records of 4,953 patients undergoing TA (n = 4,085) or TAo (n = 868) TAVR from 2011 to 2014 in The Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry were linked to Centers for Medicare and Medicaid Services hospital claims. Inhospital and 1-year clinical outcomes were stratified by operative risk; and the risk-adjusted association between access route and mortality, stroke, and heart failure repeat hospitalization was explored. Results Mean age for all patients was 82.8 ± 6.8 years. The median STS predicted risk of mortality was significantly higher among patients undergoing TAo (8.8 versus 7.4, p < 0.001). When compared with TA, TAo was associated with an increased risk of unadjusted 30-day mortality (10.3% versus 8.8%) and 1-year mortality (30.3% versus 25.6%, p = 0.006). There were no significant differences between TAo and TA for inhospital stroke rate (2.2%), major vascular complications (0.3%), and 1-year heart failure rehospitalizations (15.7%). Examination of high-risk and inoperable subgroups showed that 1-year mortality was significantly higher for TAo patients classified as inoperable ( p = 0.012). Conclusions Patients undergoing TAo TAVR are older, more likely female, and have significantly higher STS predicted risk of mortality scores than patients operated on by TA access. There were no risk-adjusted differences between TA and TAo access in mortality, stroke, or readmission rates as long as 1 year after TAVR.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2015.05.010</identifier><identifier>PMID: 26233276</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Aged, 80 and over ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - surgery ; Cardiac Catheterization - methods ; Cardiac Catheterization - utilization ; Cardiothoracic Surgery ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Postoperative Complications - epidemiology ; Registries ; Risk Assessment ; Risk Factors ; Surgery ; Survival Rate - trends ; Transcatheter Aortic Valve Replacement - utilization ; Treatment Outcome ; United States - epidemiology</subject><ispartof>The Annals of thoracic surgery, 2015-11, Vol.100 (5), p.1718-1727</ispartof><rights>The Society of Thoracic Surgeons</rights><rights>2015 The Society of Thoracic Surgeons</rights><rights>Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c499t-8882a3320a9c89bbf9efeb95607f233b66233d4113b29531aebad7ef53c83ab83</citedby><cites>FETCH-LOGICAL-c499t-8882a3320a9c89bbf9efeb95607f233b66233d4113b29531aebad7ef53c83ab83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26233276$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thourani, Vinod H., MD</creatorcontrib><creatorcontrib>Jensen, Hanna A., MD, PhD</creatorcontrib><creatorcontrib>Babaliaros, Vasilis, MD</creatorcontrib><creatorcontrib>Suri, Rakesh, MD, DPhil</creatorcontrib><creatorcontrib>Vemulapalli, Sreekanth, MD</creatorcontrib><creatorcontrib>Dai, David, PhD, MS</creatorcontrib><creatorcontrib>Brennan, J. Matthew, MD</creatorcontrib><creatorcontrib>Rumsfeld, John, MD, PhD</creatorcontrib><creatorcontrib>Edwards, Fred, MD</creatorcontrib><creatorcontrib>Tuzcu, E. Murat, MD</creatorcontrib><creatorcontrib>Svensson, Lars, MD, PhD</creatorcontrib><creatorcontrib>Szeto, Wilson Y., MD</creatorcontrib><creatorcontrib>Herrmann, Howard, MD</creatorcontrib><creatorcontrib>Kirtane, Ajay J., MD, SM</creatorcontrib><creatorcontrib>Kodali, Susheel, MD</creatorcontrib><creatorcontrib>Cohen, David J., MD</creatorcontrib><creatorcontrib>Lerakis, Stamatios, MD</creatorcontrib><creatorcontrib>Devireddy, Chandan, MD</creatorcontrib><creatorcontrib>Sarin, Eric, MD</creatorcontrib><creatorcontrib>Carroll, John, MD</creatorcontrib><creatorcontrib>Holmes, David, MD</creatorcontrib><creatorcontrib>Grover, Frederick L., MD</creatorcontrib><creatorcontrib>Williams, Mathew, MD</creatorcontrib><creatorcontrib>Maniar, Hersh, MD</creatorcontrib><creatorcontrib>Shahian, David, MD</creatorcontrib><creatorcontrib>Mack, Michael, MD</creatorcontrib><title>Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Background When transcatheter aortic valve replacement (TAVR) cannot be carried out through transfemoral access, alternative access TAVR is indicated. The purpose of this study was to explore inhospital and 1-year outcomes of patients undergoing alternative access TAVR through the transapical (TA) or transaortic (TAo) techniques in the United States. Methods Clinical records of 4,953 patients undergoing TA (n = 4,085) or TAo (n = 868) TAVR from 2011 to 2014 in The Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry were linked to Centers for Medicare and Medicaid Services hospital claims. Inhospital and 1-year clinical outcomes were stratified by operative risk; and the risk-adjusted association between access route and mortality, stroke, and heart failure repeat hospitalization was explored. Results Mean age for all patients was 82.8 ± 6.8 years. The median STS predicted risk of mortality was significantly higher among patients undergoing TAo (8.8 versus 7.4, p < 0.001). When compared with TA, TAo was associated with an increased risk of unadjusted 30-day mortality (10.3% versus 8.8%) and 1-year mortality (30.3% versus 25.6%, p = 0.006). There were no significant differences between TAo and TA for inhospital stroke rate (2.2%), major vascular complications (0.3%), and 1-year heart failure rehospitalizations (15.7%). Examination of high-risk and inoperable subgroups showed that 1-year mortality was significantly higher for TAo patients classified as inoperable ( p = 0.012). Conclusions Patients undergoing TAo TAVR are older, more likely female, and have significantly higher STS predicted risk of mortality scores than patients operated on by TA access. There were no risk-adjusted differences between TA and TAo access in mortality, stroke, or readmission rates as long as 1 year after TAVR.</description><subject>Aged, 80 and over</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Cardiac Catheterization - methods</subject><subject>Cardiac Catheterization - utilization</subject><subject>Cardiothoracic Surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Postoperative Complications - epidemiology</subject><subject>Registries</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Survival Rate - trends</subject><subject>Transcatheter Aortic Valve Replacement - utilization</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUU1P3DAQtSpQ2dL-hcpHLtn6Y53EFyRA0CIhIfHRHq2JMxFess5iO0j773EUChInpJHsGb-ZN36PEMrZkjNe_lovIT0MAWwcw1IwrpYsB2dfyIIrJYpSKL1HFowxWax0pQ7ItxjXORX5-Ss5EKWQUlTlgvy7C-AjbJ2FnoJv6ZwPITk7322mwoSBnszFv9A_I73BbQ8WN-gTdZ5mCL33LmFLbxMkjN_Jfgd9xB-v5yG5vzi_O_tTXF3_vjw7uSrsSutU1HUtIK_CQNtaN02nscNGq5JVXV6xKadF2xXnshFaSQ7YQFthp6StJTS1PCRH89xtGJ5GjMlsXLTY9-BxGKPhldBSCcVVhtYz1IYhxoCd2Qa3gbAznJlJVrM277KaSVbDcnCWW3--sozNBtu3xv86ZsDpDMD812eHwUTr0FtsXUCbTDu4z7Acfxhie-cnZx5xh3E9jMFnLQ03URhmbid7J3e5YqyWecALhxajnw</recordid><startdate>20151101</startdate><enddate>20151101</enddate><creator>Thourani, Vinod H., MD</creator><creator>Jensen, Hanna A., MD, PhD</creator><creator>Babaliaros, Vasilis, MD</creator><creator>Suri, Rakesh, MD, DPhil</creator><creator>Vemulapalli, Sreekanth, MD</creator><creator>Dai, David, PhD, MS</creator><creator>Brennan, J. Matthew, MD</creator><creator>Rumsfeld, John, MD, PhD</creator><creator>Edwards, Fred, MD</creator><creator>Tuzcu, E. Murat, MD</creator><creator>Svensson, Lars, MD, PhD</creator><creator>Szeto, Wilson Y., MD</creator><creator>Herrmann, Howard, MD</creator><creator>Kirtane, Ajay J., MD, SM</creator><creator>Kodali, Susheel, MD</creator><creator>Cohen, David J., MD</creator><creator>Lerakis, Stamatios, MD</creator><creator>Devireddy, Chandan, MD</creator><creator>Sarin, Eric, MD</creator><creator>Carroll, John, MD</creator><creator>Holmes, David, MD</creator><creator>Grover, Frederick L., MD</creator><creator>Williams, Mathew, MD</creator><creator>Maniar, Hersh, MD</creator><creator>Shahian, David, MD</creator><creator>Mack, Michael, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20151101</creationdate><title>Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States</title><author>Thourani, Vinod H., MD ; Jensen, Hanna A., MD, PhD ; Babaliaros, Vasilis, MD ; Suri, Rakesh, MD, DPhil ; Vemulapalli, Sreekanth, MD ; Dai, David, PhD, MS ; Brennan, J. Matthew, MD ; Rumsfeld, John, MD, PhD ; Edwards, Fred, MD ; Tuzcu, E. Murat, MD ; Svensson, Lars, MD, PhD ; Szeto, Wilson Y., MD ; Herrmann, Howard, MD ; Kirtane, Ajay J., MD, SM ; Kodali, Susheel, MD ; Cohen, David J., MD ; Lerakis, Stamatios, MD ; Devireddy, Chandan, MD ; Sarin, Eric, MD ; Carroll, John, MD ; Holmes, David, MD ; Grover, Frederick L., MD ; Williams, Mathew, MD ; Maniar, Hersh, MD ; Shahian, David, MD ; Mack, Michael, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c499t-8882a3320a9c89bbf9efeb95607f233b66233d4113b29531aebad7ef53c83ab83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged, 80 and over</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Cardiac Catheterization - methods</topic><topic>Cardiac Catheterization - utilization</topic><topic>Cardiothoracic Surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Postoperative Complications - epidemiology</topic><topic>Registries</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Survival Rate - trends</topic><topic>Transcatheter Aortic Valve Replacement - utilization</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thourani, Vinod H., MD</creatorcontrib><creatorcontrib>Jensen, Hanna A., MD, PhD</creatorcontrib><creatorcontrib>Babaliaros, Vasilis, MD</creatorcontrib><creatorcontrib>Suri, Rakesh, MD, DPhil</creatorcontrib><creatorcontrib>Vemulapalli, Sreekanth, MD</creatorcontrib><creatorcontrib>Dai, David, PhD, MS</creatorcontrib><creatorcontrib>Brennan, J. Matthew, MD</creatorcontrib><creatorcontrib>Rumsfeld, John, MD, PhD</creatorcontrib><creatorcontrib>Edwards, Fred, MD</creatorcontrib><creatorcontrib>Tuzcu, E. Murat, MD</creatorcontrib><creatorcontrib>Svensson, Lars, MD, PhD</creatorcontrib><creatorcontrib>Szeto, Wilson Y., MD</creatorcontrib><creatorcontrib>Herrmann, Howard, MD</creatorcontrib><creatorcontrib>Kirtane, Ajay J., MD, SM</creatorcontrib><creatorcontrib>Kodali, Susheel, MD</creatorcontrib><creatorcontrib>Cohen, David J., MD</creatorcontrib><creatorcontrib>Lerakis, Stamatios, MD</creatorcontrib><creatorcontrib>Devireddy, Chandan, MD</creatorcontrib><creatorcontrib>Sarin, Eric, MD</creatorcontrib><creatorcontrib>Carroll, John, MD</creatorcontrib><creatorcontrib>Holmes, David, MD</creatorcontrib><creatorcontrib>Grover, Frederick L., MD</creatorcontrib><creatorcontrib>Williams, Mathew, MD</creatorcontrib><creatorcontrib>Maniar, Hersh, MD</creatorcontrib><creatorcontrib>Shahian, David, MD</creatorcontrib><creatorcontrib>Mack, Michael, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thourani, Vinod H., MD</au><au>Jensen, Hanna A., MD, PhD</au><au>Babaliaros, Vasilis, MD</au><au>Suri, Rakesh, MD, DPhil</au><au>Vemulapalli, Sreekanth, MD</au><au>Dai, David, PhD, MS</au><au>Brennan, J. Matthew, MD</au><au>Rumsfeld, John, MD, PhD</au><au>Edwards, Fred, MD</au><au>Tuzcu, E. Murat, MD</au><au>Svensson, Lars, MD, PhD</au><au>Szeto, Wilson Y., MD</au><au>Herrmann, Howard, MD</au><au>Kirtane, Ajay J., MD, SM</au><au>Kodali, Susheel, MD</au><au>Cohen, David J., MD</au><au>Lerakis, Stamatios, MD</au><au>Devireddy, Chandan, MD</au><au>Sarin, Eric, MD</au><au>Carroll, John, MD</au><au>Holmes, David, MD</au><au>Grover, Frederick L., MD</au><au>Williams, Mathew, MD</au><au>Maniar, Hersh, MD</au><au>Shahian, David, MD</au><au>Mack, Michael, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2015-11-01</date><risdate>2015</risdate><volume>100</volume><issue>5</issue><spage>1718</spage><epage>1727</epage><pages>1718-1727</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><abstract>Background When transcatheter aortic valve replacement (TAVR) cannot be carried out through transfemoral access, alternative access TAVR is indicated. The purpose of this study was to explore inhospital and 1-year outcomes of patients undergoing alternative access TAVR through the transapical (TA) or transaortic (TAo) techniques in the United States. Methods Clinical records of 4,953 patients undergoing TA (n = 4,085) or TAo (n = 868) TAVR from 2011 to 2014 in The Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry were linked to Centers for Medicare and Medicaid Services hospital claims. Inhospital and 1-year clinical outcomes were stratified by operative risk; and the risk-adjusted association between access route and mortality, stroke, and heart failure repeat hospitalization was explored. Results Mean age for all patients was 82.8 ± 6.8 years. The median STS predicted risk of mortality was significantly higher among patients undergoing TAo (8.8 versus 7.4, p < 0.001). When compared with TA, TAo was associated with an increased risk of unadjusted 30-day mortality (10.3% versus 8.8%) and 1-year mortality (30.3% versus 25.6%, p = 0.006). There were no significant differences between TAo and TA for inhospital stroke rate (2.2%), major vascular complications (0.3%), and 1-year heart failure rehospitalizations (15.7%). Examination of high-risk and inoperable subgroups showed that 1-year mortality was significantly higher for TAo patients classified as inoperable ( p = 0.012). Conclusions Patients undergoing TAo TAVR are older, more likely female, and have significantly higher STS predicted risk of mortality scores than patients operated on by TA access. There were no risk-adjusted differences between TA and TAo access in mortality, stroke, or readmission rates as long as 1 year after TAVR.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>26233276</pmid><doi>10.1016/j.athoracsur.2015.05.010</doi><tpages>10</tpages></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged, 80 and over Aortic Valve Stenosis - mortality Aortic Valve Stenosis - surgery Cardiac Catheterization - methods Cardiac Catheterization - utilization Cardiothoracic Surgery Female Follow-Up Studies Humans Incidence Male Postoperative Complications - epidemiology Registries Risk Assessment Risk Factors Surgery Survival Rate - trends Transcatheter Aortic Valve Replacement - utilization Treatment Outcome United States - epidemiology |
| title | Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States |
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