title: Role of different vascular approaches on transcatheter aortic valve implantation outcome: a single-center study.
abstract: OBJECTIVE
  To compare different vascular approaches on clinical outcome of patients undergoing transcatheter aortic valve implantation (TAVI) with self-expandable bioprosthesis.
  
  
  METHODS
  We included all the patients undergoing CoreValve implantation at our institute between September 2007 and March 2014. They were divided into four groups based on the vascular approach: percutaneous transfemoral (pTF), cut-down transfemoral (cTF), transaxillary (TAx) and transaortic (TAo). Clinical outcomes were evaluated according to Valve Academic Research Consortium-2 recommendations.
  
  
  RESULTS
  Out of 322 consecutive patients, 170 (53%) underwent pTF, 76 (23%) cTF, 32 (10%) TAx and 44 (14%) TAo approach. Although the TAx and TAo patients had a higher risk profile, they had a similar outcome compared with the pTF and cTF groups; in particular, there were no differences regarding cardiovascular and all-cause mortality at 30 days, 1 and 2 years, as well as stroke, myocardial infarction, bleeding, major vascular complications, permanent pacemaker implantation and acute kidney injury rates. The observed device success rate was higher in the TAo than in the other approaches (88.6 versus 65.9, 68.7 and 76.3% in the pTF, cTF and TAx groups, respectively; P = 0.019). No differences occurred regarding 30-day early safety and 1-year clinical efficacy across the four groups. Fluoroscopy time, amount of contrast medium used and minor vascular complications were significantly higher in pTF patients, as well as in-hospital stay in the TAo group. Atrial fibrillation and prosthetic valve regurgitation, but not the vascular approach, were independent predictors of all-cause mortality.
  
  
  CONCLUSIONS
  A more invasive vascular approach, for CoreValve implantation, even in higher risk patients, does not affect early-term, mid-term and long-term outcomes.
authors.affiliation: aCardiac Catheterization Laboratory, Cardiothoracic Department Spedali Civili, Brescia bDivision of Cardiac Surgery, Cardiothoracic Department Spedali Civili, Brescia cDivision of Cardiothoracic Anesthesiology, Cardiothoracic Department Spedali Civili, Brescia dInstitute of Cardiology; Cardiothoracic Department Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia eDivision of Vascular Surgery, Spedali Civili; Department of Clinical and Sperimental Sciences- University of Brescia, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Adamo
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.forename: Salvatore
authors.initials: S
authors.lastname: Curello
authors.forename: Diego
authors.initials: D
authors.lastname: Maffeo
authors.forename: Giuliano
authors.initials: G
authors.lastname: Chizzola
authors.forename: Gerardo
authors.initials: G
authors.lastname: Di Matteo
authors.forename: Rosa
authors.initials: R
authors.lastname: Mastropierro
authors.forename: Matilde
authors.initials: M
authors.lastname: Nardi
authors.forename: Edoardo
authors.initials: E
authors.lastname: Cervi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Cicco
authors.forename: Ermanna
authors.initials: E
authors.lastname: Chiari
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonardelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Coletti
authors.forename: Aldo
authors.initials: A
authors.lastname: Manzato
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology; D001366:Axillary Artery; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D018570:Risk Assessment; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome