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Published on: December 11, 2017
Long-term outcomes of transapical-transcatheter aortic valve replacement
Koichi Maeda1, Kazuo Shimamura2, Isamu Mizote3
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan. k-maeda@surg1.med.osaka-u.ac.jp.
Insights
Transapical-transcatheter aortic valve replacement offers satisfactory long-term outcomes for patients with challenging vascular access. This minimally invasive approach remains a viable option, demonstrating significant survival and low stroke rates over time.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- Transapical-transcatheter aortic valve replacement (TA-TAVR) is crucial for patients with difficult peripheral access.
- Long-term outcome data for TA-TAVR were previously lacking.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of transapical-transcatheter aortic valve replacement.
- To assess survival, cardiovascular mortality, and stroke rates following TA-TAVR.
Main Methods:
- Retrospective analysis of 173 patients with native aortic stenosis undergoing TA-TAVR.
- Evaluation of early and long-term results, including survival and freedom from adverse events.
Main Results:
- Mean follow-up was 4.3 years; 8-year survival was 22.1%.
- 8-year freedom from cardiovascular mortality was 53.5%; 8-year freedom from disabling stroke was 90.8%.
- Male gender and hemodialysis were identified as poor prognostic factors.
Conclusions:
- Transapical-transcatheter aortic valve replacement demonstrates satisfactory long-term outcomes.
- The procedure, with its low vascular impact, retains a significant role despite alternative approaches.
Objective:
Transapical-transcatheter aortic valve replacement is one of the main interventions indicated for patients where access via peripheral vessels is challenging. However, there have been no reports on the long-term outcomes of this intervention. Here, we report the long-term outcomes of this intervention.
Methods:
Among 178 patients who underwent transapical-transcatheter aortic valve replacement between October 2009 and July 2023, 173 patients who underwent this intervention for native aortic stenosis were included in this study, and early and long-term results were evaluated.
Results:
The mean age was 82.4 ± 6.4 years, 52.6% were women, mean body area was 1.46 ± 0.17 m2, and the Society of Thoracic Surgeons Predicted Risk of Mortality was 11.2 ± 9.9%. In-hospital mortality was observed in three patients (1.7%). Mean follow-up duration was 4.3 ± 2.8 years, and the survival rates at 1-, 3-, 5-, and 8-years were 84.9%, 67.1%, 47.0%, and 22.1%, respectively. Freedom from cardiovascular mortality at 1, 3, 5, and 8-years was 92.9%, 86.1%, 75.8%, and 53.5%, respectively. The freedom from disabling stroke rates at 1, 3, 5, and 8-years were 95.0%, 92.4%, 92.4%, and 90.8%, respectively. Multivariate analysis revealed that male (Hazard Ratio 1.85, 95%Confidence Interval 1.27-2.70, p = 0.0012) and hemodialysis (Hazard Ratio 1.64, 95%Confidence Interval 1.00-2.67, p = 0.049) were significant poor prognosis factors.
Conclusions:
Long-term outcomes of transapical-transcatheter aortic valve replacement were satisfactory. Despite the variety of available approaches, the role of transapical-transcatheter aortic valve replacement, which has low vascular impact, has not been completely lost.
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