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Transaortic transcatheter aortic valve implantation as a first-line choice or as a last resort? An analysis based on the ROUTE registry

Bonaros, Nikolaos ; Petzina, Rainer ; Cocchieri, Riccardo ; Jagielak, Dariusz ; Aiello, Marco ; Lapeze, Joel ; Laine, Mika ; Chocron, Sidney ; Muir, Douglas ; Eichinger, Walter ; Thielmann, Matthias ; Labrousse, Louis ; Bapat, Vinayak ; Arne Rein, Kjell ; Verhoye, Jean-Philippe ; Gerosa, Gino ; Baumbach, Hardy ; Kofler, Markus ; Bramlage, Peter ; Deutsch, Cornelia ; Thoenes, Martin ; Frank, Derk ; Romano, Mauro

European journal of cardio-thoracic surgery, 2017-05, Vol.51 (5), p.919-926 [Periódico revisado por pares]

Germany: Oxford University Press

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Transaortic transcatheter aortic valve implantation as a first-line choice or as a last resort? An analysis based on the ROUTE registry
Autor: Bonaros, Nikolaos ; Petzina, Rainer ; Cocchieri, Riccardo ; Jagielak, Dariusz ; Aiello, Marco ; Lapeze, Joel ; Laine, Mika ; Chocron, Sidney ; Muir, Douglas ; Eichinger, Walter ; Thielmann, Matthias ; Labrousse, Louis ; Bapat, Vinayak ; Arne Rein, Kjell ; Verhoye, Jean-Philippe ; Gerosa, Gino ; Baumbach, Hardy ; Kofler, Markus ; Bramlage, Peter ; Deutsch, Cornelia ; Thoenes, Martin ; Frank, Derk ; Romano, Mauro
Assuntos: Aged ; Aged, 80 and over ; Aortic Valve - surgery ; Female ; Humans ; Male ; Postoperative Complications ; Prospective Studies ; Registries ; Transcatheter Aortic Valve Replacement - adverse effects ; Transcatheter Aortic Valve Replacement - methods ; Transcatheter Aortic Valve Replacement - mortality ; Transcatheter Aortic Valve Replacement - statistics & numerical data ; Treatment Outcome
É parte de: European journal of cardio-thoracic surgery, 2017-05, Vol.51 (5), p.919-926
Notas: ObjectType-Article-1
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Descrição: Abstract OBJECTIVES: Transaortic transcatheter aortic valve implantation (TAo-TAVI) is a recently developed alternative to transapical (TA) or transfemoral (TF) TAVI. We aimed to analyse the effectiveness and safety of TAo-TAVI as a first line approach and to compare it to patients receiving TAo-TAVI as a last resort, which is current practice. METHODS: ROUTE is a prospective, multicentre registry to assess the clinical outcomes of TAo-TAVI. Patients without contraindications for TA- and TF-TAVI (TAo-first) were compared to patients with contraindications for both of these access routes (TAo-last). Outcome analysis was based on VARC II defined clinical end-points. RESULTS: Three hundred and one patients were included, of which 224 patients met TAo-first and 77 TAo-last criteria. The valve was delivered and catheter retrieved successfully in all patients. In the TAo-first group, rates of conversion to open surgery and requirement for a second valve were low and not different compared to TAo-last patients (1% vs. 3%, P = 0.46 and 1% vs. 3%, P = 0.46, respectively). This was also true for the rate of paravalvular regurgitation (≥ moderate: 4% vs. 3%). All-cause mortality at 30-days was 6% vs. 5% (P = 0.76), rates of stroke 2% vs. 0% (P = 0.24), pacemaker implantation (11% vs. 4%, P = 0.093), and life-threatening bleeding 4% vs. 3% (P = 0.70). Valve safety (both 85%, P = 0.98) and clinical efficacy (80% vs. 82%; P = 0.73) did not differ between groups. CONCLUSIONS: Although comparative data to TA and TF procedures were not available in the present analysis, findings suggest that TAo may be considered not only as a last resort strategy when classical access routes are deemed unfeasible, but also as a potential first-line option, with only low rates of paravalvular regurgitation and permanent pacemaker implantation. Clinicaltrials.gov: NCT01991431
Editor: Germany: Oxford University Press
Idioma: Inglês

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Transaortic transcatheter aortic valve implantation as a first-line choice or as a last resort? An analysis based on the ROUTE registry

Germany: Oxford University Press

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