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Transcatheter Aortic Procedure Assessed in High-Risk Patients

Last Updated: January 21, 2010.

Transcatheter aortic valve implantation, using either transfemoral or transapical approaches, produces similar mortality, and both are viable alternatives for patients with severe aortic stenosis who are at too high a risk for surgery, according to a study published online Jan. 20 in the Journal of the American College of Cardiology.

THURSDAY, Jan. 21 (HealthDay News) -- Transcatheter aortic valve implantation (TAVI), using either transfemoral or transapical approaches, produces similar mortality, and both are viable alternatives for patients with severe aortic stenosis who are at too high a risk for surgery, according to a study published online Jan. 20 in the Journal of the American College of Cardiology.

Josep Rodés-Cabau, M.D., of Laval University in Quebec City, and colleagues evaluated outcomes for 345 patients with severe aortic stenosis who underwent TAVI via either transfemoral or transapical approaches because of surgery risks, porcelain aorta or frailty. Procedural and 30-day outcomes were evaluated, and the patients were followed for a median of eight months. Outcomes were compared with predictions of surgical risk score calculators.

The researchers found that the mortality rates were as follows: overall, 10.4 percent; transfemoral approach, 9.5 percent; and transapical approach, 11.3 percent. During follow-up, the overall mortality rate was 22.1 percent. The predictors for late mortality were periprocedural sepsis (hazard ratio, 3.49), required hemodynamic support (hazard ratio, 2.58), chronic kidney disease (hazard ratio, 2.30), pulmonary hypertension (hazard ratio, 1.88), and chronic obstructive pulmonary disease (hazard ratio, 1.75). Within the study population, outcomes were similar for patients with porcelain aorta or frailty.

"A TAVI program including both transfemoral and transapical approaches was associated with comparable mortality as predicted by surgical risk calculators for the treatment of patients at very high or prohibitive surgical risk, including porcelain aorta and frail patients," the authors write.

Several authors reported serving as consultants or being speakers for Edwards Lifesciences or ATS Medical.

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