Trends in Circulatory Device Use in patients undergoing Trans-catheter Aortic Valve Replacement Comparing Transfemoral with Transapical approach

Background:
In this study, we sought to determine the temporal trend in utilization of transfemoral vs. transapical approach for TAVR and mortality in patients undergoing TAVR in a national dataset representative of nationwide practices and outcomes of this procedure

Methods
Data the National Inpatient sample database were queried to identify adult patients undergoing TAVR (35.05, 35.06) between 2011 and 2014 using International Classification of diseases, Ninth edition (ICD-9). Patients were classified into TF and TA groups. Demographics, co-morbid conditions, complications like acute kidney injury, stroke and death were queried. Percentage of patient requiring Extra-corporal membrane oxygenation (ECMO), left ventricular assist device (LVAD) and intra-aortic balloon pump (IABP) use were also extracted. Propensity score matching was performed using neighborhood matching with a 1: 2 ratio and outcomes compared after matching with t-test and Pearson’s Chi-squared tests as appropriate between the two groups.

Results
Overall, a total of 8484 adults patients with TAVR procedures were identified (weighted 42357), 6771 in TF group and 1713 the TA group. There was a remarkable increase in number of procedures in both TA (340 in 2011 to 3130 in 2014) and TF (877 in 2011 to 16770 in 2014) (P-trend < 0.001). We matched 1546 patients in the TA group with 3092 patients in the TF group. Patients in the TA group had a longer mean length of stay (10 vs 7.7; P=<.0001), a worse rate of AKI (24.9% VS 17.3%, P=<. 0.001) and a higher in-hospital mortality (5.2% vs 4.1%; P=.108). Rate of stroke was not statistically significantly different between the two groups (2.8% vs 2.6%). Regarding circulatory device use, rate of IABP use was doubled in the TA group (3.23% vs 1.48%; P= =<.0001), however both groups had equivalent utilization of LVAD (0.20% vs 0.24%; P= =.645) and ECMO (0.32% vs 0.26%; P= =.695).

Conclusions
Transapical approach is associated with worse outcomes and more utilization use of IABP when compared to transfemoral approach, however there is no statistically significant difference in use of LVAD and ECMO.