Suprasternal Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: Insights From a Propensity Score Matched Analysis

BACKGROUND: Suprasternal access is an alternative access strategy for transcatheter aortic valve replacement (TAVR) where the innominate artery is cannulated from an incision above the sternal notch. To date, suprasternal access has never been compared with transfemoral TAVR. Thus, we sought to asse...

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Autores principales: Brener, Michael I., Olds, Anna, Nemeth, Samantha, Kurlansky, Paul, Nazif, Tamim M., Vahl, Torsten P., Khalique, Omar K., Hamid, Nadira B., Patel, Amisha, Ng, Vivian G., Chen, Shmuel, Cahill, Thomas J., Rahim, Hussein M., Hahn, Rebecca T., Bapat, Vinayak, Sarraf, Mohammad, Ahmed, Mustafa I., Leon, Martin B., Kodali, Susheel, Eudailey, Kyle W., George, Isaac
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475036/
https://www.ncbi.nlm.nih.gov/pubmed/34376060
http://dx.doi.org/10.1161/JAHA.120.020491
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author Brener, Michael I.
Olds, Anna
Nemeth, Samantha
Kurlansky, Paul
Nazif, Tamim M.
Vahl, Torsten P.
Khalique, Omar K.
Hamid, Nadira B.
Patel, Amisha
Ng, Vivian G.
Chen, Shmuel
Cahill, Thomas J.
Rahim, Hussein M.
Hahn, Rebecca T.
Bapat, Vinayak
Sarraf, Mohammad
Ahmed, Mustafa I.
Leon, Martin B.
Kodali, Susheel
Eudailey, Kyle W.
George, Isaac
author_facet Brener, Michael I.
Olds, Anna
Nemeth, Samantha
Kurlansky, Paul
Nazif, Tamim M.
Vahl, Torsten P.
Khalique, Omar K.
Hamid, Nadira B.
Patel, Amisha
Ng, Vivian G.
Chen, Shmuel
Cahill, Thomas J.
Rahim, Hussein M.
Hahn, Rebecca T.
Bapat, Vinayak
Sarraf, Mohammad
Ahmed, Mustafa I.
Leon, Martin B.
Kodali, Susheel
Eudailey, Kyle W.
George, Isaac
author_sort Brener, Michael I.
collection PubMed
description BACKGROUND: Suprasternal access is an alternative access strategy for transcatheter aortic valve replacement (TAVR) where the innominate artery is cannulated from an incision above the sternal notch. To date, suprasternal access has never been compared with transfemoral TAVR. Thus, we sought to assess safety, feasibility, and early clinical outcomes between suprasternal and transfemoral access for patients undergoing TAVR. METHODS AND RESULTS: We evaluated patients from 2 institutional prospective, observational registries containing 1348 patients. Patients were selected in a 2:1 ratio (transfemoral:suprasternal) on the basis of propensity score matching. The primary outcome was in‐hospital mortality, and secondary outcomes included the incidence of ischemic stroke, major bleeding, vascular injury, left bundle‐branch block, and permanent pacemaker implantation at 30‐day follow‐up. Propensity score matching identified 89 patients undergoing suprasternal TAVR and 159 patients undergoing transfemoral TAVR suitable for analysis. There was no significant difference between suprasternal TAVR and transfemoral TAVR with respect to in‐hospital mortality (1.1% versus 0.6%; odds ratio [OR], 1.80; 95% CI, 0.11–29.06; P=0.680). No patients in either cohort suffered an ischemic stroke. The incidence of major bleeding (2.2% versus 2.5%; OR, 0.89; 95% CI, 0.16–4.96; P=0.895) and vascular injury (1.1% versus 1.9%; OR, 0.59; 95% CI, 0.06–5.77; P=0.651) did not differ significantly. The frequency of left bundle‐branch block (9.4% versus 15.8%; OR, 0.56; 95% CI, 0.24–1.30; P=0.177) and permanent pacemaker implantation (11.2% versus 5.9%; OR, 2.01; 95% CI, 0.75–5.45; P=0.169) were not statistically significantly different. CONCLUSIONS: Suprasternal TAVR was safe and achieved promising short‐term clinical outcomes when compared with transfemoral TAVR. Future studies seeking to identify the optimal alternative access site should evaluate suprasternal TAVR access alongside other substitutes for transfemoral TAVR.
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spelling pubmed-84750362021-10-01 Suprasternal Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: Insights From a Propensity Score Matched Analysis Brener, Michael I. Olds, Anna Nemeth, Samantha Kurlansky, Paul Nazif, Tamim M. Vahl, Torsten P. Khalique, Omar K. Hamid, Nadira B. Patel, Amisha Ng, Vivian G. Chen, Shmuel Cahill, Thomas J. Rahim, Hussein M. Hahn, Rebecca T. Bapat, Vinayak Sarraf, Mohammad Ahmed, Mustafa I. Leon, Martin B. Kodali, Susheel Eudailey, Kyle W. George, Isaac J Am Heart Assoc Original Research BACKGROUND: Suprasternal access is an alternative access strategy for transcatheter aortic valve replacement (TAVR) where the innominate artery is cannulated from an incision above the sternal notch. To date, suprasternal access has never been compared with transfemoral TAVR. Thus, we sought to assess safety, feasibility, and early clinical outcomes between suprasternal and transfemoral access for patients undergoing TAVR. METHODS AND RESULTS: We evaluated patients from 2 institutional prospective, observational registries containing 1348 patients. Patients were selected in a 2:1 ratio (transfemoral:suprasternal) on the basis of propensity score matching. The primary outcome was in‐hospital mortality, and secondary outcomes included the incidence of ischemic stroke, major bleeding, vascular injury, left bundle‐branch block, and permanent pacemaker implantation at 30‐day follow‐up. Propensity score matching identified 89 patients undergoing suprasternal TAVR and 159 patients undergoing transfemoral TAVR suitable for analysis. There was no significant difference between suprasternal TAVR and transfemoral TAVR with respect to in‐hospital mortality (1.1% versus 0.6%; odds ratio [OR], 1.80; 95% CI, 0.11–29.06; P=0.680). No patients in either cohort suffered an ischemic stroke. The incidence of major bleeding (2.2% versus 2.5%; OR, 0.89; 95% CI, 0.16–4.96; P=0.895) and vascular injury (1.1% versus 1.9%; OR, 0.59; 95% CI, 0.06–5.77; P=0.651) did not differ significantly. The frequency of left bundle‐branch block (9.4% versus 15.8%; OR, 0.56; 95% CI, 0.24–1.30; P=0.177) and permanent pacemaker implantation (11.2% versus 5.9%; OR, 2.01; 95% CI, 0.75–5.45; P=0.169) were not statistically significantly different. CONCLUSIONS: Suprasternal TAVR was safe and achieved promising short‐term clinical outcomes when compared with transfemoral TAVR. Future studies seeking to identify the optimal alternative access site should evaluate suprasternal TAVR access alongside other substitutes for transfemoral TAVR. John Wiley and Sons Inc. 2021-08-11 /pmc/articles/PMC8475036/ /pubmed/34376060 http://dx.doi.org/10.1161/JAHA.120.020491 Text en © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Brener, Michael I.
Olds, Anna
Nemeth, Samantha
Kurlansky, Paul
Nazif, Tamim M.
Vahl, Torsten P.
Khalique, Omar K.
Hamid, Nadira B.
Patel, Amisha
Ng, Vivian G.
Chen, Shmuel
Cahill, Thomas J.
Rahim, Hussein M.
Hahn, Rebecca T.
Bapat, Vinayak
Sarraf, Mohammad
Ahmed, Mustafa I.
Leon, Martin B.
Kodali, Susheel
Eudailey, Kyle W.
George, Isaac
Suprasternal Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: Insights From a Propensity Score Matched Analysis
title Suprasternal Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: Insights From a Propensity Score Matched Analysis
title_full Suprasternal Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: Insights From a Propensity Score Matched Analysis
title_fullStr Suprasternal Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: Insights From a Propensity Score Matched Analysis
title_full_unstemmed Suprasternal Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: Insights From a Propensity Score Matched Analysis
title_short Suprasternal Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: Insights From a Propensity Score Matched Analysis
title_sort suprasternal versus transfemoral access for transcatheter aortic valve replacement: insights from a propensity score matched analysis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475036/
https://www.ncbi.nlm.nih.gov/pubmed/34376060
http://dx.doi.org/10.1161/JAHA.120.020491
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