title: Preoperative Risk Levels and Vascular Access in Transcatheter Aortic Valve Implantation-A Single-Institute Analysis.
abstract: Although transcatheter aortic valve implantation (TAVI) has been indicated for patients with high surgical risk, indications for or against the procedure become more difficult as vascular access becomes more proximal and/or invasive in order to accommodate patients with even higher risks. We compared preoperative factors including the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score with postoperative survival in 195 patients undergoing TAVI during 2.5 years (January 2010 to June 2012), when vascular access routes were developed from iliofemoral (IL/Fm access, n = 149), axillo-clavicular, apical, and direct aortic approaches (alternative access, n = 46). Logistic regression analyses showed that alternative access was associated with reduced 30-day survival (P = 0.024), while high surgical risk (>15% in both EuroSCORE and STS score) was associated with reduced 1-year survival (P = 0.046). Thus, patients treated via IL/Fm access had acceptable outcome regardless of preoperative risk levels while patients with low surgical risk (<15%) had favorable outcome irrespective of access route. Since the remaining patients with combined risk factors, high preoperative risk level (>15%) requiring alternative access, had a prohibitive risk in our experience, they might have been considered untreatable or not amenable even to TAVI and offered medical or alternative managements.
authors.affiliation: Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.|Tokai University School of Medicine, Isehara.
authors.forename: Akira T
authors.initials: AT
authors.lastname: Kawaguchi
authors.affiliation: Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cluzel
authors.affiliation: Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Ralouka
authors.initials: R
authors.lastname: Makri
authors.affiliation: Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Mojgan
authors.initials: M
authors.lastname: Laali
authors.affiliation: Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: DeFrance
authors.affiliation: Tokai University School of Medicine, Isehara.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Furuya
authors.affiliation: Matsue National College of Technology, Matsue, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Murakami
authors.affiliation: Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D057234:Preoperative Period; D012307:Risk Factors; D016019:Survival Analysis; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
keywords: EuroSCORE; Preoperative risk stratification; STS score; Single-institute experience; Transcatheter aortic valve implantation; Vascular access; Vascular occlusive disease