Abstract
Introduction: The outcomes of transfemoral (TF) compared with transapical (TA) access for transcatheter aortic valve replacement (TAVR) in diabetics are unknown. Methods: We queried the NIS database (2011–2014) to identify diabetics who underwent TAVR. We performed a propensity matching analysis comparing TF-TAVR versus TA-TAVR. Results: The analysis included 14.555 diabetics who underwent TAVR. After matching, in-hospital mortality was not different between TF-TAVR and TA-TAVR. (3.5 vs. 4.4%, p = 0.11). TF-TAVR was associated with lower rates of cardiogenic shock (2.7 vs. 4.7%, p = 0.02), use of mechanical circulatory support (2.0 vs. 2.9%, p = 0.03), acute renal failure (17.8 vs. 26.5%, p < 0.001), major bleeding (35.8 vs. 40.7%, p < 0.001) and respiratory complications (1.1 vs. 4.4%, p < 0.001) compared with TA-TAVR. However, TF-TAVR was associated with a higher rate of vascular complications (2.9 vs. 0.9%, p < 0.001), cardiac tamponade (0.5 vs. 0.0%, p < 0.001), complete heart block (10.8 vs. 7.7%, p < 0.001) and pacemaker insertion (11.8 vs. 8.3%, p < 0.001). There was no difference between both groups in acute stroke (1.8 vs. 2.2%, p = 0.39), hemodialysis (2.0 vs. 2.2%, p = 0.71), and ventricular arrhythmias (4.9 vs. 4.2%, p = 0.19). Notably, TF-TAVR was associated with higher mortality, acute stroke, AKI, hemodialysis, PCI, and respiratory complications in complicated diabetics compared with non-complicated diabetics. Conclusions: This observational analysis showed no difference in-hospital mortality between TF-TAVR and TA-TAVR among diabetic patients. Studies exploring the optimal access for TAVR among diabetics are recommended.
| Original language | English |
|---|---|
| Pages (from-to) | 107-118 |
| Number of pages | 12 |
| Journal | Cardiology and Therapy |
| Volume | 9 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jun 1 2020 |
Bibliographical note
Publisher Copyright:© 2019, The Author(s).
Funding
No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. An abstract for this manuscript was presented at the Society for Cardiovascular Angiography & Interventions (SCAI) annual meeting May 2019, Las Vegas, NV, USA. Ayman Elbadawi, Ahmed H. Mohamed, Mohamed A. Omer, Islam Y. Elgendy, Ahmed Abuzaid, Gbolahan Ogunbayo, Michael Megaly, Hend I Shahin, Karim Mahmoud, Ken Fujise, and Syed Gilani have nothing to disclose. This study was exempt from local institutional review board, since the NIS contains de-identified data that are publicly available. All data generated or analyzed during this study are included in this published article/as supplementary information files. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
| Funders | Funder number |
|---|---|
| Ken Fujise | |
| Society for Cardiovascular Angiography & Interventions |
Keywords
- Diabetics
- Transapical access
- Transcatheter aortic valve replacement
- Transfemoral access
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
