31 Clinical outcomes of transfemoral vs transapical tavi: uk single-centre early tavi experience

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Abstract

Background

Transcather Aortic Valve Replacement (TAVI) started at Barts Health NHS Trust (London Chest Hospital) in 2008. It was the beginning of a new era for patients with severe aortic stenosis who were not fit enough for surgery; giving another treatment opportunity to our patients.

Methods

Data was collected on patients who underwent TAVI between January 2009-January 2015, comparing transapical (TA) and transfemoral (TF) approaches using appropriate statistical tests. The clinical outcomes included 30 day mortality, mean Log-EuroScore, renal function and complications.

Results

Over the 6 years, there was a total of 79 TA (39.1%) and 123 TF (60.9%) TAVI procedures. 30 day mortality included TA 3.8% Vs TF 4.1% (p=0.213); with Mean Log-EuroScore being 19.68 TA and 20.07 TF (p=0.879), which improved over the years. Mean hospital stay for TA was 13 days and TF was 11 days.

Results

Patients who had an eGFR<60 and received a contrast volume>150 ml was 36.8% in TA patients and 35.8% in TF patients. With the former patient group, TA patients had a statistically significant post-TAVI AKI with worsening eGFR than TF (p=0.0013). Also, these TA patients had a longer hospital admission (mean=18.14 days) compared to TF (mean=10.32 days). Those patients with eGFR<60 and received<150 ml contrast had similar outcomes in TA patients (p=<0.0001) however there was a 1 mean day difference in hospital stay.

Results

The complications during TAVI procedures included major bleeding (TA 6.33% Vs TF 9.76% p=0.081), arrhythmia/cardiac arrest (TA 3.80% Vs TF 0.81% p=0.408) and cardiac tamponade (TA 0% Vs TF 4.07% p=0.185). Other complications like para-prosthetic leak accounted for TA 8.47% Vs TF 14% (p=0.700), and intra-operative regurgitation TA 11.43% Vs 21.28%TF (p=0.589).

Conclusions

Both TA and TF approaches were observed to have similar clinical outcomes over those 6 years, except for those TA patients with poor renal function (eGFR<60), who face worsening post-TAVI AKI and requiring longer hospital stay for recovery; despite the contrast volume received. Overall, TAVIs have been successful at Barts Health since it began, therefore the number of cases is expanding every year.

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