Elevated plasma B-type natriuretic peptide level predicts 30-day and 1-year mortality after transapical but not transfemoral transcatheter aortic valve implantation

Abstract

Purpose: Evaluate the predictive value of B-type natriuretic peptide (BNP) levels for 30-day and 1-year mortality after transfemoral (TF-) and transapical (TA-) transcatheter aortic valve implantation (TAVI) Methods: Plasma BNP was measured in 419 consecutive patients who underwent TAVI in our center either through TF- or TA- access at least one day before procedure. Results: 419 consecutive patients underwent TAVI in our center. TF- access was used in 308 patients and TA- access in 111 patients. 39 (9%) patients died at 30-day after procedure and 74 (18%) patients died at 1-year after procedure. Baseline BNP was 540±837 pg/ml in whole group with a trend towards higher baseline BNP in TF- patients (561±846 pg/ml) compared to TA- patients (484±814 pg/ml), p= 0.07. Baseline Ln-BNP was lower in 30-day survivors (5.6 vs. 6.0, p= 0.04) as well as 1-year survivors (5.6 vs. 5.9, p= 0.02) versus non survivors in the whole patients population and in TA- subgroup (5.4 vs. 6.3, p= 0.009 for 30-day mortality and 5.3 vs. 6.1, p= 0.001 for 1-year mortality), while TF- subgroup showed no significant difference in Ln-BNP between survivors and non survivors (5.7 vs. 5.9, p= 0.4 for 30-day mortality and 5.7 vs. 5.8, p= 0.4 for 1-year mortality). Kaplan Meier survival analysis showed increased 30-day mortality (13% vs. 3%, p= 0.001) and 1-year mortality (23% vs. 9%, p 195 pg/ml in the whole population and in TA- subgroup (19% vs. 0%, p= 0.002 for 30-day mortality and 37% vs. 4%, p 195 pg/ml had significantly higher 1-year mortality compared to TF- subgroup (37% vs. 18%, p= 0.003). Conclusion: Baseline plasma BNP is a useful outcome predictor in TA- but not in TF-TAVI. TF-TAVI may provide a better outcome than TA-TAVI in patients with baseline BNP> 195 pg/ml.