Left ventricular remodeling and function after transapical versus transfemoral transcatheter aortic valve replacement

Mohammed A. Al-Hijji, Chad J. Zack, Vuyisile T. Nkomo, Sorin V. Pislaru, Patricia A. Pellikka, Guy S. Reeder, Kevin L. Greason, Charanjit S. Rihal, Mackram F. Eleid

Research output: Contribution to journalArticle

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Abstract

Background: The effect of utilizing transapical (TA) access for transcatheter aortic valve replacement (TAVR) on cardiac function has not been well studied. Aims: The aim of this retrospective study is to determine the direct effects of TA access for TAVR on myocardial function parameters and their correlation with 4-year survival. Methods: Three hundred and thirty propensity matched patients, who underwent TAVR using Sapien valve (Edwards Lifesciences Corp, Irvine, CA) between February 15, 2012 and June 17, 2016 (115 TA and 115 transfemoral [TF] routes) were studied. The pre- and 1 month post-TAVR echocardiographic features of both groups were compared. The 4-year survival in both groups was analyzed. Results: Baseline clinical characteristics, diastolic function parameters, left ventricular (LV) chamber size, and ejection fraction were similar between matched TA and TF groups. At 1 month following TAVR, there was a significant increase in stroke volume index (SVI) in both TA (mean increase 7 cm3/m2; P = 0.03) and TF groups (mean increase 7 cm3/m2; P < 0.001). Left ventricular ejection fraction (LVEF) significantly increased post TF TAVR (mean increase 2%; P = 0.008), but no significant increase was observed post TA TAVR (mean increase 1%; P = 0.27). Both groups had significant improvement in aortic valve (AV) hemodynamics post-TAVR (P < 0.001). Overall, there were no significant differences in the mean change of SVI, LVEF, or left ventricular end diastolic dimensions (LVEDDs) post TA versus TF TAVR. There was no significant difference in 4-year survival in the TF compared to TA group (49% vs 50%, P = 0.43). Conclusion: Both TA and TF TAVR were equally associated with favorable changes in LV SVI and AV hemodynamics in 30 days. TA TAVR patients had similar 4 year survival to propensity matched TF TAVR; therefore, TA TAVR remains an acceptable alternative access route in patients not amenable to TF TAVR.

Original languageEnglish (US)
Pages (from-to)738-744
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume94
Issue number5
DOIs
StatePublished - Nov 1 2019

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Ventricular Remodeling
Left Ventricular Function
Stroke Volume
Survival
Transcatheter Aortic Valve Replacement
Aortic Valve
Hemodynamics

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Al-Hijji, Mohammed A. ; Zack, Chad J. ; Nkomo, Vuyisile T. ; Pislaru, Sorin V. ; Pellikka, Patricia A. ; Reeder, Guy S. ; Greason, Kevin L. ; Rihal, Charanjit S. ; Eleid, Mackram F. / Left ventricular remodeling and function after transapical versus transfemoral transcatheter aortic valve replacement. In: Catheterization and Cardiovascular Interventions. 2019 ; Vol. 94, No. 5. pp. 738-744.
@article{3848910f3fde4071b150df14bccd62df,
title = "Left ventricular remodeling and function after transapical versus transfemoral transcatheter aortic valve replacement",
abstract = "Background: The effect of utilizing transapical (TA) access for transcatheter aortic valve replacement (TAVR) on cardiac function has not been well studied. Aims: The aim of this retrospective study is to determine the direct effects of TA access for TAVR on myocardial function parameters and their correlation with 4-year survival. Methods: Three hundred and thirty propensity matched patients, who underwent TAVR using Sapien valve (Edwards Lifesciences Corp, Irvine, CA) between February 15, 2012 and June 17, 2016 (115 TA and 115 transfemoral [TF] routes) were studied. The pre- and 1 month post-TAVR echocardiographic features of both groups were compared. The 4-year survival in both groups was analyzed. Results: Baseline clinical characteristics, diastolic function parameters, left ventricular (LV) chamber size, and ejection fraction were similar between matched TA and TF groups. At 1 month following TAVR, there was a significant increase in stroke volume index (SVI) in both TA (mean increase 7 cm3/m2; P = 0.03) and TF groups (mean increase 7 cm3/m2; P < 0.001). Left ventricular ejection fraction (LVEF) significantly increased post TF TAVR (mean increase 2{\%}; P = 0.008), but no significant increase was observed post TA TAVR (mean increase 1{\%}; P = 0.27). Both groups had significant improvement in aortic valve (AV) hemodynamics post-TAVR (P < 0.001). Overall, there were no significant differences in the mean change of SVI, LVEF, or left ventricular end diastolic dimensions (LVEDDs) post TA versus TF TAVR. There was no significant difference in 4-year survival in the TF compared to TA group (49{\%} vs 50{\%}, P = 0.43). Conclusion: Both TA and TF TAVR were equally associated with favorable changes in LV SVI and AV hemodynamics in 30 days. TA TAVR patients had similar 4 year survival to propensity matched TF TAVR; therefore, TA TAVR remains an acceptable alternative access route in patients not amenable to TF TAVR.",
author = "Al-Hijji, {Mohammed A.} and Zack, {Chad J.} and Nkomo, {Vuyisile T.} and Pislaru, {Sorin V.} and Pellikka, {Patricia A.} and Reeder, {Guy S.} and Greason, {Kevin L.} and Rihal, {Charanjit S.} and Eleid, {Mackram F.}",
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Al-Hijji, MA, Zack, CJ, Nkomo, VT, Pislaru, SV, Pellikka, PA, Reeder, GS, Greason, KL, Rihal, CS & Eleid, MF 2019, 'Left ventricular remodeling and function after transapical versus transfemoral transcatheter aortic valve replacement', Catheterization and Cardiovascular Interventions, vol. 94, no. 5, pp. 738-744. https://doi.org/10.1002/ccd.28074

Left ventricular remodeling and function after transapical versus transfemoral transcatheter aortic valve replacement. / Al-Hijji, Mohammed A.; Zack, Chad J.; Nkomo, Vuyisile T.; Pislaru, Sorin V.; Pellikka, Patricia A.; Reeder, Guy S.; Greason, Kevin L.; Rihal, Charanjit S.; Eleid, Mackram F.

In: Catheterization and Cardiovascular Interventions, Vol. 94, No. 5, 01.11.2019, p. 738-744.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Left ventricular remodeling and function after transapical versus transfemoral transcatheter aortic valve replacement

AU - Al-Hijji, Mohammed A.

AU - Zack, Chad J.

AU - Nkomo, Vuyisile T.

AU - Pislaru, Sorin V.

AU - Pellikka, Patricia A.

AU - Reeder, Guy S.

AU - Greason, Kevin L.

AU - Rihal, Charanjit S.

AU - Eleid, Mackram F.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Background: The effect of utilizing transapical (TA) access for transcatheter aortic valve replacement (TAVR) on cardiac function has not been well studied. Aims: The aim of this retrospective study is to determine the direct effects of TA access for TAVR on myocardial function parameters and their correlation with 4-year survival. Methods: Three hundred and thirty propensity matched patients, who underwent TAVR using Sapien valve (Edwards Lifesciences Corp, Irvine, CA) between February 15, 2012 and June 17, 2016 (115 TA and 115 transfemoral [TF] routes) were studied. The pre- and 1 month post-TAVR echocardiographic features of both groups were compared. The 4-year survival in both groups was analyzed. Results: Baseline clinical characteristics, diastolic function parameters, left ventricular (LV) chamber size, and ejection fraction were similar between matched TA and TF groups. At 1 month following TAVR, there was a significant increase in stroke volume index (SVI) in both TA (mean increase 7 cm3/m2; P = 0.03) and TF groups (mean increase 7 cm3/m2; P < 0.001). Left ventricular ejection fraction (LVEF) significantly increased post TF TAVR (mean increase 2%; P = 0.008), but no significant increase was observed post TA TAVR (mean increase 1%; P = 0.27). Both groups had significant improvement in aortic valve (AV) hemodynamics post-TAVR (P < 0.001). Overall, there were no significant differences in the mean change of SVI, LVEF, or left ventricular end diastolic dimensions (LVEDDs) post TA versus TF TAVR. There was no significant difference in 4-year survival in the TF compared to TA group (49% vs 50%, P = 0.43). Conclusion: Both TA and TF TAVR were equally associated with favorable changes in LV SVI and AV hemodynamics in 30 days. TA TAVR patients had similar 4 year survival to propensity matched TF TAVR; therefore, TA TAVR remains an acceptable alternative access route in patients not amenable to TF TAVR.

AB - Background: The effect of utilizing transapical (TA) access for transcatheter aortic valve replacement (TAVR) on cardiac function has not been well studied. Aims: The aim of this retrospective study is to determine the direct effects of TA access for TAVR on myocardial function parameters and their correlation with 4-year survival. Methods: Three hundred and thirty propensity matched patients, who underwent TAVR using Sapien valve (Edwards Lifesciences Corp, Irvine, CA) between February 15, 2012 and June 17, 2016 (115 TA and 115 transfemoral [TF] routes) were studied. The pre- and 1 month post-TAVR echocardiographic features of both groups were compared. The 4-year survival in both groups was analyzed. Results: Baseline clinical characteristics, diastolic function parameters, left ventricular (LV) chamber size, and ejection fraction were similar between matched TA and TF groups. At 1 month following TAVR, there was a significant increase in stroke volume index (SVI) in both TA (mean increase 7 cm3/m2; P = 0.03) and TF groups (mean increase 7 cm3/m2; P < 0.001). Left ventricular ejection fraction (LVEF) significantly increased post TF TAVR (mean increase 2%; P = 0.008), but no significant increase was observed post TA TAVR (mean increase 1%; P = 0.27). Both groups had significant improvement in aortic valve (AV) hemodynamics post-TAVR (P < 0.001). Overall, there were no significant differences in the mean change of SVI, LVEF, or left ventricular end diastolic dimensions (LVEDDs) post TA versus TF TAVR. There was no significant difference in 4-year survival in the TF compared to TA group (49% vs 50%, P = 0.43). Conclusion: Both TA and TF TAVR were equally associated with favorable changes in LV SVI and AV hemodynamics in 30 days. TA TAVR patients had similar 4 year survival to propensity matched TF TAVR; therefore, TA TAVR remains an acceptable alternative access route in patients not amenable to TF TAVR.

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