title: Propensity-matched comparisons of clinical outcomes after transapical or transfemoral transcatheter aortic valve replacement: a placement of aortic transcatheter valves (PARTNER)-I trial substudy.
abstract: BACKGROUND
  The higher risk of adverse outcomes after transapical (TA) versus transfemoral (TF) transcatheter aortic valve replacement (TAVR) could be attributable to TA-TAVR being an open surgical procedure or to clinical differences between TA- and TF-TAVR patients. We compared outcomes after neutralizing patient differences using propensity score matching.
  
  
  RESULTS
  From April 2007 to February 2012, 1100 Placement of Aortic Transcatheter Valves (PARTNER)-I patients underwent TA-TAVR and 1521 underwent TF-TAVR with Edwards SAPIEN balloon-expandable bioprostheses. Propensity matching based on 111 preprocedural variables, exclusive of femoral access morphology, identified 501 well-matched patient pairs (46% of possible matches), 95% of whom had peripheral arterial disease. Matched TA-TAVR patients experienced more adverse procedural events, longer length of stay (5 versus 8 days; P<0.0001), and slower recovery (New York Heart Association class I, 31% versus 38% at 30 days, equalizing by 6 months at 51% versus 47%); stroke risk was similar (3.4% versus 3.3% at 30 days and 6.0% versus 6.7% at 3 years); mortality was elevated for the first 6 postprocedural months (19% versus 12%; P=0.01); but aortic regurgitation was less (34% versus 52% mild and 8.9% versus 12% moderate to severe at discharge, P=0.001; 36% versus 50% mild and 10% versus 15% moderate to severe at 6 months, P<0.0001).
  
  
  CONCLUSIONS
  The likelihood of adverse periprocedural events and prolonged recovery is greater after TA-TAVR than TF-TAVR in vasculopathic patients after accounting for differences in cardiovascular risk factors, although stroke risk is equivalent and aortic regurgitation is less. As smaller delivery systems permit TF-TAVR in many of these patients, we recommend a TF-first access strategy for TAVR when anatomically feasible.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed. blackse@ccf.org.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Samir
authors.initials: S
authors.lastname: Kapadia
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Susheel K
authors.initials: SK
authors.lastname: Kodali
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Williams
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Jodi J
authors.initials: JJ
authors.lastname: Akin
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: From Cleveland Clinic, Cleveland, OH (E.H.B., J.R., S.K., E.M.T., L.G.S.); Mayo Clinic, Rochester, MN (R.M.S.); Emory University, Atlanta, GA (V.B., V.H.T.); Duke University Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.); Stanford University Medical Center, Stanford, CA (W.F.F., D.C.M.); Columbia University Medical Center/New York-Presbyterian Hospital, New York (R.T.H., A.J.K., S.K.K., M.B.L.); Baylor Scott & White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); and New York University Langone Medical Center, New York (M.R.W.). J.J. Akin is self-employed.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality / Q000639:trends; D057216:Propensity Score; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D016896:Treatment Outcome
keywords: aortic valve insufficiency; mortality; propensity score; stroke; transcatheter aortic valve replacement