Comparative Outcomes of Transfemoral Versus Transapical Access for Transcatheter Aortic Valve Replacement in Diabetics
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Ayman Elbadawi
,
University of Texas Medical Branch at Galveston, Galveston, TX
Gbolahan O Ogunbayo, M.D.
,
University of Kentucky, Lexington, KY
Michael S Megaly, M.D.
,
Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, MN
Islam Y Elgendy, M.D.
,
University of Florida College of Medicine, Gainesville, FL
Marwan Saad, M.D., Ph.D.
,
Brown University Program, Warwick, RI
Background:
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 using 18 clinical variables comparing TF-TAVR versus TA-TAVR.
Results:
Our final 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=0.108). TF-TAVR was associated with lower rates of cardiogenic shock (2.7% vs. 4.7%, p=0.020), use of mechanical circulatory support (2.0% vs. 2.9%, p=0.028), 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%) compared with TA-TAVR. However, TF-TAVR was associated with 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=0.386). Subgroup analysis showed that TF-TAVR was associated with higher mortality in complicated diabetics and lower mortality in non-complicated diabetics, compared with TA-TAVR (P
interaction<0.001)
Conclusions:
Real world data showed no difference in-hospital mortality between TF-TAVR and TA-TAVR among diabetic patients. Patients with complicated DM might have higher in-hospital mortality with TF-TAVR compared with TA-TAVR.
