title: Long-term results of transapical versus transfemoral TAVI in a real world population of 1000 patients with severe symptomatic aortic stenosis.
abstract: BACKGROUND
  Transapical transcatheter aortic valve implantation is generally perceived to be associated with increased morbidity compared with transfemoral transcatheter aortic valve implantation. We aimed to compare access-related complications and survival using propensity score matching.
  
  
  RESULTS
  Prospective, single-center registry of 1000 consecutive patients undergoing transapical and transfemoral transcatheter aortic valve implantation between May 2008 and April 2012. Transapical was performed in 413 patients and transfemoral in 587 patients. Patients with transapical access were less often women and less had pulmonary hypertension. Further they had more peripheral arterial disease, coronary artery disease, carotid stenosis, and recurrent surgery and a higher logistic EuroSCORE I (24.3% ± 16.2% for transapical versus 22.2% ± 16.2% for transfemoral; P < 0.01). After building 2 propensity score-matched groups of 354 patients each with either access route (total 708 patients), baseline characteristics were comparable. In this analysis, there was no significant difference in 30 day mortality (5.9% transapical versus 8.5% transfemoral; P = 0.19), the rate of myocardial infarction (2.5% transapical versus 2.0% transfemoral; P = 0.61), stroke (2.0% transapical versus 2.3% transfemoral; P = 0.79), bleeding complications, pacemaker implantation rates, or moderate aortic insufficiency. Stage 1 renal complications were more common in transapical patients (odds ratio, 2.81; 95% confidence interval, 1.93-4.09), whereas major vascular complications were less common (odds ratio, 0.14; 95% confidence interval, 0.06-0.29). Survival probability over the long term was not statistically different (hazard ratio, 0.89; 95% confidence interval, 0.72-1.10; log-rank Test, P = 0.27).
  
  
  CONCLUSIONS
  The data demonstrate that in an experienced multidisciplinary heart team, either access route can be performed with comparable results.
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.). gerhard.schymik@klinikum-karlsruhe.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schymik
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Würth
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Tanja
authors.initials: T
authors.lastname: Herbinger
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Martin
authors.initials: M
authors.lastname: Heimeshoff
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Lothar
authors.initials: L
authors.lastname: Pilz
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Jan S
authors.initials: JS
authors.lastname: Schymik
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Rainer
authors.initials: R
authors.lastname: Wondraschek
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Tim
authors.initials: T
authors.lastname: Süselbeck
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Jan
authors.initials: J
authors.lastname: Gerhardus
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Armin
authors.initials: A
authors.lastname: Luik
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Bernd-Dieter
authors.initials: BD
authors.lastname: Gonska
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Herbert
authors.initials: H
authors.lastname: Posival
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: From the Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Germany (G.S., T.H., R.W., A.L., C.S.); Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Germany (A.W., J.G., B.-D.G.); Institut für Pharmakologie und präventive Medizin, Mahlow, Germany (P.B.); Clinic for Cardiac Surgery Karlsruhe, Germany (M.H., H.P., H.S.); Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (L.P.); Munich Graduate School of Economics LMU Munich, Germany (J.S.S.); and Medical Clinic I-Department of Cardiology, Mannheim University, Germany (T.S.).
authors.forename: Holger
authors.initials: H
authors.lastname: Schröfel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006321:Heart / Q000033:anatomy & histology*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis*; D057216:Propensity Score; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000209:etiology; D016019:Survival Analysis; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: aortic valve replacement; mortality; transcatheter