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Apical vs subclavian transcatheter aortic valve implantation: an 8-year United Kingdom analysis
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  • Francesca D'Auria,
  • Danilo Flavio Santo,
  • Aung Myat,
  • Roberto Lorusso,
  • Justine Ravaux,
  • Uday Trivedi,
  • David Hildick-Smith
Francesca D'Auria
Cardiac Center Brighton and Sussex University Hospital Brighton and Hove United Kingdom

Corresponding Author:f.dauria@hotmail.com

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Danilo Flavio Santo
Cardiac Center Brighton and Sussex University Hospital Brighton and Hove United Kingdom
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Aung Myat
Cardiac Center Brighton and Sussex University Hospital Brighton and Hove United Kingdom
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Roberto Lorusso
Cardio-Thoracic Surgery Department - Heart & Vascular Centre - Maastricht University Medical Centre (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM) Maastricht Netherlands
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Justine Ravaux
Cardio-Thoracic Surgery Department - Heart & Vascular Centre - Maastricht University Medical Centre (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM) Maastricht Netherlands
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Uday Trivedi
Cardiac Center Brighton and Sussex University Hospital Brighton and Hove United Kingdom
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David Hildick-Smith
Cardiac Center Brighton and Sussex University Hospital Brighton and Hove United Kingdom
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Abstract

Objectives: Subclavian (SC) and transapical (TA) approach are the main alternatives to the default femoral delivery for transcatheter aortic valve implantation (TAVI). Aim of this study was to compare, complications and morbidity/mortality associated with SC and TA in a long-term time frame. Methods: From January 2007 to July 2015, 1,506 patients underwent TAVI surgery in 36 United Kingdom TAVI centres. Primary outcomes were complications according to VARC-2 criteria. The secondary outcome was long-term survival. Results: The enrolled patients were distributed as follows: 1,216 in the trans-apical (TA) group and 290 in the subclavian (SC) group. There were no differences in the rates of acute myocardial infarction, emergency valve-in-valve, paravalvular leak, balloon post dilatation, cardiac tamponade, stroke, renal replacement therapy, vascular injuries, and 30-days mortality among the groups. Conversely, the rate of permanent pacemaker implantation (p = 0.02), the procedural time duration (p = 0.04), and the 12-month mortality (p = 0.03) was higher in SC than in TA, while in-hospital length of stay was reduced in SC than in TA (p = 0.01). Up to 8-years, the long-term mortality was not different among groups (p = 0.77), and no difference in long-term survival between self vs balloon expandable device was found (p = 0.26). Conclusions: According to our results, TA provided the best 12-months survival compared to SC, while the long-term survival up to 2, 900 days is not significantly different between groups, so SC and TA may both represent a safe non-femoral access if femoral is precluded.
08 Nov 2021Submitted to Journal of Cardiac Surgery
08 Nov 2021Submission Checks Completed
08 Nov 2021Assigned to Editor
09 Nov 2021Reviewer(s) Assigned
19 Nov 2021Review(s) Completed, Editorial Evaluation Pending
19 Nov 2021Editorial Decision: Revise Major
03 Dec 20211st Revision Received
04 Dec 2021Submission Checks Completed
04 Dec 2021Assigned to Editor
06 Dec 2021Reviewer(s) Assigned
20 Dec 2021Review(s) Completed, Editorial Evaluation Pending
20 Dec 2021Editorial Decision: Accept