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31 Clinical outcomes of transfemoral vs transapical tavi: uk single-centre early tavi experience
  1. Mahvesh Javaid,
  2. Nabeela Kareem,
  3. Simon Kennon,
  4. Wael Awad
  1. Barts Health NHS Trust

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.

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.

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.

  • TAVI
  • Transapical
  • Transfemoral

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