{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T07:30:11Z","timestamp":1776497411949,"version":"3.51.2"},"reference-count":14,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T00:00:00Z","timestamp":1610582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) approaches on mortality and identify effect modifiers and predictors for mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Alternative access routes to transfemoral (TF) TAVI include the surgical intra\u2010thoracic direct\u2010aortic (DA) and transapical (TA) approach. TA TAVI has been associated with a higher mortality rate. We hypothesized that this is related to effect modifiers, in particular the left ventricular ejection fraction (LVEF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multicentre study derived its data from prospective registries. To adjust for confounders, we used propensity\u2010score based, stabilized inverse probability weighted Cox regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 5,910 patients underwent TAVI via TF (<jats:italic>N<\/jats:italic>\u00a0=\u20094,072), DA (<jats:italic>N<\/jats:italic>\u00a0=\u2009524), and TA (<jats:italic>N<\/jats:italic>\u00a0=\u20091,314) access. Compared to TF, 30\u2010day mortality was increased among DA (HR 1.87, 95%CI 1.26\u20132.78, <jats:italic>p<\/jats:italic>\u00a0=\u2009.002) and TA (HR 3.34, 95%CI 2.28\u20134.89, <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001) cases. Compared to TF, 5\u2010year mortality was increased among TA cases (HR 1.50, 95%CI 1.24\u20131.83, <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001). None of the variables showed a significant interaction between the approaches and mortality. An impaired LVEF (\u226435%) increased mortality in all approaches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The surgical intra\u2010thoracic TA and DA TAVI are both associated with a higher 30\u2010day mortality than TF TAVI. TA TAVI is associated with a higher 5\u2010year mortality than TF TAVI. The DA approach may therefore have some advantages over the TA approach when TF access is not feasible.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.29456","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T19:40:11Z","timestamp":1610739611000},"page":"1462-1469","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The effect of transcatheter aortic valve implantation approaches on mortality"],"prefix":"10.1002","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0030-7427","authenticated-orcid":false,"given":"Vincent J.","family":"Nijenhuis","sequence":"first","affiliation":[{"name":"Department of Cardiology St. Antonius Hospital  Nieuwegein The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery German Heart Center Berlin  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7815-1031","authenticated-orcid":false,"given":"Jorn","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Department of Cardiology St. Antonius Hospital  Nieuwegein The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bakhtawar K.","family":"Mahmoodi","sequence":"additional","affiliation":[{"name":"Department of Cardiology St. Antonius Hospital  Nieuwegein The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Unbehaun","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery German Heart Center Berlin  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Spaziano","sequence":"additional","affiliation":[{"name":"Department of Cardiology H\u00f4pital Priv\u00e9 Jacques Cartier  Massy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7713-3739","authenticated-orcid":false,"given":"Nicola","family":"Buzzatti","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit San Raffaele Scientific Institute  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anja","family":"Stundl","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Bonn  Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Troels H.","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology the Heart Centre  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3630-683X","authenticated-orcid":false,"given":"Nynke H.M.","family":"Kooistra","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3855-1815","authenticated-orcid":false,"given":"Marianna","family":"Adamo","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Spedali Civili University of Brescia  Brescia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Smriti","family":"Saraf","sequence":"additional","affiliation":[{"name":"Department of Cardiology Royal Sussex County Hospital  Brighton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hafid","family":"Amrane","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Medisch Centrum Leeuwarden  Leeuwarden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Bruschi","sequence":"additional","affiliation":[{"name":"\"De Gasperis\" Cardio Center ASST Niguarda General Hospital  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9825-6589","authenticated-orcid":false,"given":"Carlo","family":"Zivelonghi","sequence":"additional","affiliation":[{"name":"Heart Centre Middelheim Hospital  Antwerp Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin J.","family":"Swaans","sequence":"additional","affiliation":[{"name":"Department of Cardiology St. Antonius Hospital  Nieuwegein The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikos","family":"Werner","sequence":"additional","affiliation":[{"name":"Heart Center Trier, Department of Internal Medicine III \u2013 Cardiology Hospital Barmherzige Br\u00fcder Trier  Trier Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"Nickenig","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Bonn  Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Hildick\u2010Smith","sequence":"additional","affiliation":[{"name":"Department of Cardiology Royal Sussex County Hospital  Brighton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pieter R.","family":"Stella","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9035-343X","authenticated-orcid":false,"given":"Azeem","family":"Latib","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit San Raffaele Scientific Institute  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"Soendergaard","sequence":"additional","affiliation":[{"name":"Department of Cardiology the Heart Centre  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan\u2010Malte","family":"Sinning","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Bonn  Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thierry","family":"Lefevre","sequence":"additional","affiliation":[{"name":"Department of Cardiology H\u00f4pital Priv\u00e9 Jacques Cartier  Massy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miralem","family":"Pasic","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery German Heart Center Berlin  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorg","family":"Kempfert","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery German Heart Center Berlin  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jurrien M.","family":"ten Berg","sequence":"additional","affiliation":[{"name":"Department of Cardiology St. Antonius Hospital  Nieuwegein The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,1,14]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx391"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1114705"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.012525"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.05.010"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.08.035"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.03.039"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.09.001"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2008.01.046"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.113.000761"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2010.03.044"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2016.04.028"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.08.068"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.881"},{"key":"e_1_2_9_15_1","first-page":"110","article-title":"Does the transapical approach impair early recovery of systolic strain following transcatheter aortic valve replacement?","volume":"5","author":"Ando T","year":"2015","journal-title":"Am J Cardiovasc Dis"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.29456","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.29456","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.29456","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T15:09:42Z","timestamp":1693408182000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.29456"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,14]]},"references-count":14,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1002\/ccd.29456"],"URL":"https:\/\/doi.org\/10.1002\/ccd.29456","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,14]]},"assertion":[{"value":"2020-08-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-14","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}