title: Do outcomes from transcatheter aortic valve implantation vary according to access route and valve type? The UK TAVI Registry.
abstract: OBJECTIVE
  To determine whether outcomes from transcatheter aortic valve implantation (TAVI) vary according to access route and valve type in a real-world population.
  
  
  BACKGROUND
  Registry and uncontrolled trial data have found that patients undergoing nonfemoral TAVI have higher early and late mortality. It is not clear whether worse outcomes relate directly to access route. There have been no direct comparisons of outcomes according to valve type.
  
  
  METHODS
  Data were collected prospectively on 1,620 patients undergoing TAVI in the UK and compared in 4 groups: SAPIEN transfemoral (TF); SAPIEN transapical (TA); CoreValve TF, CoreValve subclavian. Univariable and multivariable regression analysis was performed to identify independent predictors of mortality.
  
  
  RESULTS
  Mortality in patients undergoing SAPIEN TAVI via a TA approach was higher than with TF at 30 days (11.2% vs. 4.4%, P < 0.01), 1 year (28.7% vs. 18.1%, P = 0.01), and 2 years (56.0% vs. 43.5%, P = 0.01). Logistic EuroSCORE was higher in TA patients (22.5 ± 12.9% vs. 17.7 ± 11.1%, P < 0.0001). After multivariable analysis TA access was associated with increased mortality at 30 days (OR 2.56, 95% CI 1.46-4.48, P < 0.01) and 2 years (OR 1.75, 1.08-2.74, P = 0.02). There was no significant difference in mortality at any time-point between patients treated with SAPIEN (n = 812) and CoreValve (n = 808) prostheses. CoreValve-treated patients had a higher rate of permanent pacemaker implantation (23.1% vs. 7.2%, P < 0.0001), and grade ≥2 aortic regurgitation on postprocedure echocardiography (13.0% vs. 7.3%, P < 0.01).
  
  
  CONCLUSIONS
  Patients undergoing TA TAVI experienced increased early and late mortality compared to a TF approach. Survival was not influenced by valve type.
authors.affiliation: Department of Cardiology, Leeds Teaching Hospitals, Leeds, UK.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackman
authors.forename: Paul D
authors.initials: PD
authors.lastname: Baxter
authors.forename: Chris P
authors.initials: CP
authors.lastname: Gale
authors.forename: Neil E
authors.initials: NE
authors.lastname: Moat
authors.forename: Philip A
authors.initials: PA
authors.lastname: Maccarthy
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.forename: Uday
authors.initials: U
authors.lastname: Trivedi
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.forename: Mark A
authors.initials: MA
authors.lastname: DE Belder
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D002404:Catheterization; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome