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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
In-Hospital Outcomes with Transfemoral Versus Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Peripheral Arterial Disease
Cardiovascular Revascularization Medicine, Volume 21, No. 5, Year 2020
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Description
Background: There is a paucity of data regarding outcomes with transfemoral (TF) versus transapical (TA) access for transcatheter aortic valve replacement (TAVR) in patients with peripheral artery disease (PAD). Methods: We queried the national inpatient sample database (NIS) (2012−2013) to identify patients with PAD who underwent TAVR. We conducted a propensity matching analysis using 25 clinical variables to compare TF-TAVR versus TA-TAVR. The main outcome was in-hospital mortality. Results: The analysis included 22,349 patients who underwent TAVR, among those 6692 (29.9%) had PAD. In the matched cohort, in-hospital mortality was similar between TF-TAVR and TA-TAVR groups (4.8% vs. 5.1%, OR 0.95; 95%CI 0.74–1.21). TF-TAVR was associated with lower rates of cardiogenic shock (OR 0.64; 95%CI 0.50–0.82), use of mechanical circulatory support (OR 0.56; 95%CI 0.42–0.75), acute kidney injury (OR 0.76; 95%CI 0.67–0.86), hemodialysis (OR 0.51; 95%CI 0.36–0.71), major bleeding (OR 0.72; 95%CI 0.64–0.80), blood transfusion (OR 0.65; 95%CI 0.58–0.73), discharge to a skilled nursing facility (OR 0.61; 95%CI 0.54–0.68) as well as shorter length of hospital stay (8.13 ± 6.76 vs. 10.11 ± 7.80 days) compared with TA-TAVR. However, TF-TAVR was associated with higher rate of vascular complications (11.7% vs. 3.7%, OR 3.40; 95%CI 2.63–4.38), complete heart block (OR 1.52; 95%CI 1.23–1.87), and pacemaker insertion (OR = 1.58; 95%CI: 1.28–1.94). There was no difference between both groups in the rate of cerebrovascular accidents (OR 1.26; 95%CI 0.93–1.72). Conclusion: In this observational analysis from a large national database, there was no difference in in-hospital mortality between TF-TAVR and TA-TAVR among patients with PAD. Further studies are encouraged to identify the optimal access for TAVR in patients with PAD. © 2019 Elsevier Inc.
Authors & Co-Authors
Elbadawi, Ayman
United States, Galveston
The University of Texas Medical Branch at Galveston
Saad, Marwan
United States, Providence
The Warren Alpert Medical School
Elgendy, Islam Y.
United States, Gainesville
University of Florida
Mahmoud, Ahmad A.
United States, Gainesville
University of Florida
Megaly, Michael S.
Unknown Affiliation
Almahmoud, Mohamed Faher
United States, Galveston
The University of Texas Medical Branch at Galveston
Kleiman, Neal S.
United States, Minneapolis
Abbott Northwestern Hospital
Abbott, Jinnette Dawn
United States, Houston
Houston Methodist
Statistics
Citations: 5
Authors: 8
Affiliations: 7
Identifiers
Doi:
10.1016/j.carrev.2019.09.009
ISSN:
15538389
Research Areas
Health System And Policy
Violence And Injury
Study Design
Cohort Study
Case-Control Study