Ten Years’ Experience of Transcatheter Aortic Valve Replacement at the Faculty of Medicine Siriraj Hospital: Transapical vs. Transfemoral Approach
Nattawut Wongpraparut MD¹, Pranya Sakiyalak MD², Decho Jakrapanichakul MD¹, Adisak Maneesai MD¹, Narathip Chunhamaneewat MD¹, Worawong Slisatkorn MD², Vithaya Chaithiraphan MD³, Roongthip Chanwanitkulchai MD³, Prayuth Rasmeehiran MD³, Sirichai Jamnongprasatporn MD¹, Asa Phichaphop MD³, Korakoth Towashiraporn MD³, Pariya Panchavinnin MD³, Chunhakasem Chotinaiwattarakul MD³, Prasert Sawasdiwipachai MD⁴, Kitima Kangawat MD¹, Rungtiwa Pongakasira, MSc³
Affiliation : ¹ Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ² Division of cardio-thoracic surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ³ Her Majesty’s Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ⁴ Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To compare 30 days mortality and clinical outcomes between transapical transcatheter aortic valve replacement (TA-TAVR) and
transfemoral transcatheter aortic valve replacement (TF-TAVR) in Thai patients who underwent transcatheter aortic valve replacement (TAVR).
Materials and Methods : The observational study included 83 consecutive patients that attended the authors’ center for TAVR between January 2009 and December 2019. The patients’ baseline demographic data and surgical risks were recorded. The clinical outcomes at 30 days and one year were prespecified targets.
Results : Eighty-three patients underwent TAVR at the authors’ center between 2009 and 2019, with 77% of them considered inoperable or at high surgical risk by the authors’ heart team. Of the 83 patients, 40 had a porcelain aorta (48.2%). The median Society of Thoracic Surgeons (STS) score and logistic EuroSCORE were 5.7 (4.6, 8.3) and 21.7 (15.2, 31.2), respectively. Twenty-two patients had a transapical approach (26.5%). The cardiovascular (CV) mortality rate was 2.4% at 30 days. The all-cause mortality 30-day rate and 1-year rate were 3.6% and 12.0%, respectively. Comparing between TA-TAVR and TF-TAVR, TA-TAVR had a significantly lower incidence of new permanent pacemaker placement after TAVR (p=0.032), but a longer length of hospital stay (p=0.087). There was a trend for a higher incidence of new onset atrial fibrillation in TA-TAVR. The all-cause mortality 30-day rate and 1-year rate were similar between TA-TAVR and TF-TAVR.
Conclusion : In Thai symptomatic severe aortic stenosis patients, of whom most patients were considered inoperable or at high surgical risk, both TA-TAVR and TF-TAVR showed acceptable short- and long-term clinical outcomes.
Received 28 December 2020 | Revised 19 March 2021 | Accepted 23 March 2021
doi.org/10.35755/jmedassocthai.2021.05.12353
Keywords : Severe aortic stenosis (severe AS), Transcatheter aortic valve replacement (TAVR), Transfemoral (TF), Transapical (TA)
