title: Long-term outcomes associated with the transaortic approach to transcatheter Aortic valve replacement.
abstract: OBJECTIVE
  We investigated the long-term safety, efficacy and clinical outcomes associated with transaortic (TAO) transcatheter aortic valve replacement (TAVR) in the United States.
  
  
  BACKGROUND
  We previously reported the technical feasibility and short-term safety of TAO TAVR. Compared to transapical (TAP) access, the TAO approach was associated with shorter median intensive care unit (ICU) length of stay (LOS) and more favorable technical learning curve. However, outcomes data beyond 30 days were lacking and the longer-term clinical consequences of this strategy were unknown.
  
  
  METHODS
  Mortality outcomes at 1 year (and longer) of 44 consecutive patients who underwent TAO TAVR in our institution were compared with that of 76 consecutive patients who underwent TAP TAVR at our site. Risk-adjusted analysis was performed in propensity-matched patients (25 from each group) to account for baseline differences.
  
  
  RESULTS
  TAO TAVR was associated with a trend towards lower all-cause mortality at 1 year compared to TAP TAVR (18% vs. 34%, P=0.09 in the overall sample; 12% vs. 40%, P=0.05 in the matched cohort). The higher probability of survival with TAO TAVR persisted after a median follow-up period of 23 months (hazard ratio [HR]=1.96, P=0.06 in the overall sample; HR=3.4, P=0.01 in the matched cohort). Cardiovascular mortality at 1 year was lower with TAO TAVR (2% vs. 22%, P=0.01 in the overall sample; 4% vs. 28%, P=0.05 in the matched cohort). ICU LOS (shorter in the TAO group) and implantation of second prosthetic valve (higher incidence in the TAP group) were independent predictors of long-term mortality.
  
  
  CONCLUSIONS
  The outcomes associated with TAO TAVR compare favorably with TAP TAVR. Our results appear to corroborate the long-term safety and efficacy of the TAO approach in TAVR patients with inadequate iliofemoral access.
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Lardizabal
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: Conrad J
authors.initials: CJ
authors.lastname: Macon
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: Brian P
authors.initials: BP
authors.lastname: O'Neill
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: Harit
authors.initials: H
authors.lastname: Desai
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Martinez
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Alfonso
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Heldman
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
authors.affiliation: The Multi-Disciplinary Structural Heart Disease Program of the University of Miami - Miller School of Medicine, Miami, FL.
authors.forename: Donald B
authors.initials: DB
authors.lastname: Williams
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D057216:Propensity Score; D011474:Prosthesis Design; D012042:Registries; D019233:Retreatment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Aortic Stenosis; Heart Valve Surgery; Interventional Cardiology; Structural Heart Disease