title: Radiation Exposure and Contrast Volume Differ between Transapical and Transfemoral Aortic Valve Implantation with the Edwards SAPIEN Aortic Valve.
abstract: BACKGROUND
  To date, little is known about the radiation exposure and the amount of contrast medium given during the transcatheter aortic valve implantation (TAVI) procedure. This study compares our data between the transfemoral (TF) approach and the transapical (TA) approach.
  
  
  METHODS
  A total of 216 TA and 180 TF implantations of the Edwards SAPIEN (Edwards Lifesciences, Irvine, California, United States) valve were consecutively performed by our heart team, consisting of cardiac surgeons and cardiologists. Fluoroscopy time, dose area product, and contrast volume were compared between both the approaches.
  
  
  RESULTS
  TF-TAVI showed higher values of fluoroscopy time (13.1 ± 5.9 vs. 7.0 ± 5.7 minutes, p < 0.001), dose area product (5.0 ± 3.9 vs. 2.7 ± 1.9 mGy·m(2), p < 0.001), and contrast volume (196.7 ± 72.7 vs. 109.2 ± 33.8 mL, p < 0.001). All physicians performing the TF approach exceeded the mean values of the surgeons performing the TA approach. Some physicians showed a trend toward lower values with growing experience. Vascular complications and postdilatation had only a minor impact on the study parameters.
  
  
  CONCLUSIONS
  TA-TAVI showed an advantage over TF-TAVI in terms of lower fluoroscopy time, dose area product, and contrast use. This was hardly reflected in the past and should be considered when comparing invasiveness of both methods. However, human factors also play a role as most physicians showed a learning curve toward lower values over time.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau bei Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hartrumpf
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau bei Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Erb
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau bei Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Zytowski
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau bei Berlin, Germany.
authors.forename: Ralf-Uwe
authors.initials: RU
authors.lastname: Kuehnel
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau bei Berlin, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Aigner
authors.affiliation: Department of Cardiology, Heart Center Brandenburg, Bernau bei Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Butter
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Brandenburg, Bernau bei Berlin, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Albes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects*; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D000069079:Radiation Exposure; D011832:Radiation Injuries / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*
chemical_list: D003287:Contrast Media