Comparative Outcomes of Transapical Versus Transfemoral Access for Transcatheter Aortic Valve Replacement in Diabetics

Ayman Elbadawi; Ahmed H. Mohamed; Islam Y. Elgendy; Gbolahan O. Ogunbayo; Michael Megaly; Hend I. Shahin; Karim Mahmoud; Mohamed A. Omer; Ahmed Abuzaid; Ken Fujise; Syed Gilani

doi:10.1007/s40119-019-00155-5

Comparative Outcomes of Transapical Versus Transfemoral Access for Transcatheter Aortic Valve Replacement in Diabetics

Ayman Elbadawi
, Ahmed H. Mohamed
, Islam Y. Elgendy
, Gbolahan O. Ogunbayo
, Michael Megaly
, Hend I. Shahin
, Karim Mahmoud
, Mohamed A. Omer
, Ahmed Abuzaid
, Ken Fujise
, Syed Gilani

Producción científica: Article › revisión exhaustiva

3 Citas (Scopus)

Resumen

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.

Idioma original	English
Páginas (desde-hasta)	107-118
Número de páginas	12
Publicación	Cardiology and Therapy
Volumen	9
N.º	1
DOI	https://doi.org/10.1007/s40119-019-00155-5
Estado	Published - jun 1 2020

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Publisher Copyright:
© 2019, The Author(s).

Financiación

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.

Financiadores
Ken Fujise
Society for Cardiovascular Angiography & Interventions

ODS de las Naciones Unidas

Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

Good health and well being

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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title = "Comparative Outcomes of Transapical Versus Transfemoral Access for Transcatheter Aortic Valve Replacement in Diabetics",

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.",

keywords = "Diabetics, Transapical access, Transcatheter aortic valve replacement, Transfemoral access",

author = "Ayman Elbadawi and Mohamed, \{Ahmed H.\} and Elgendy, \{Islam Y.\} and Ogunbayo, \{Gbolahan O.\} and Michael Megaly and Shahin, \{Hend I.\} and Karim Mahmoud and Omer, \{Mohamed A.\} and Ahmed Abuzaid and Ken Fujise and Syed Gilani",

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year = "2020",

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doi = "10.1007/s40119-019-00155-5",

language = "English",

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T1 - Comparative Outcomes of Transapical Versus Transfemoral Access for Transcatheter Aortic Valve Replacement in Diabetics

AU - Elbadawi, Ayman

AU - Mohamed, Ahmed H.

AU - Elgendy, Islam Y.

AU - Ogunbayo, Gbolahan O.

AU - Megaly, Michael

AU - Shahin, Hend I.

AU - Mahmoud, Karim

AU - Omer, Mohamed A.

AU - Abuzaid, Ahmed

AU - Fujise, Ken

AU - Gilani, Syed

PY - 2020/6/1

Y1 - 2020/6/1

N2 - 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.

AB - 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.

KW - Diabetics

KW - Transapical access

KW - Transcatheter aortic valve replacement

KW - Transfemoral access

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DO - 10.1007/s40119-019-00155-5

M3 - Article

AN - SCOPUS:85111509736

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JO - Cardiology and Therapy

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Comparative Outcomes of Transapical Versus Transfemoral Access for Transcatheter Aortic Valve Replacement in Diabetics

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Financiación

ODS de las Naciones Unidas

ASJC Scopus subject areas

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