J Thorac Cardiovasc Surg 2009;138:1079-1080
© 2009 The American Association for Thoracic Surgery
Discussion
| The first 20% of the full text of this article appears below. |
Dr Michael Mack
(Dallas, Tex). My disclosure is that I am on the Executive Committee of the PARTNER Trial of the Edwards Sapien valve in the United States.
Dr Bleiziffer and the team from Munich have presented their results in just over 200 patients undergoing TAVI, with approximately 75% of the procedures being performed by a transfemoral and 25% by a transapical approach. Their analysis compares two different access approaches and concludes that transapical outcomes are adversely affected by patient selection factors such as female gender, peripheral vascular disease, cerebrovascular disease, and coronary artery disease. Although I substantially agree with this assessment, the analysis is somewhat confounded by the fact that two different valve systems were used: the CoreValve primarily but not exclusively for the transfemoral approach and the Edwards valve primarily but not exclusively for the transapical approach. I am also concerned that this was not an intent-to-treat analysis and at least 3 patients with aborted procedures or conversions were not included in the analysis.
Dr Bleiziffer, I would like to highlight some key points of your series and ask 3 questions.
First, the 30-day survival was approximately the same in both access approaches, at about 90%, yet the 6-month survival is only 80% after transfemoral and 73% after transapical. What happened to these patients between 30 days and 6 months, especially the transapical patients? Is this a patient selection issue or a . . . [Full Text of this Article]
Copyright © 2009 by The American Association for Thoracic Surgery.
