101
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Arora S, Strassle PD, Kolte D, Ramm CJ, Falk K, Jack G, Caranasos TG, Cavender MA, Rossi JS, Vavalle JP. Length of Stay and Discharge Disposition After Transcatheter Versus Surgical Aortic Valve Replacement in the United States. Circ Cardiovasc Interv 2019; 11:e006929. [PMID: 30354596 DOI: 10.1161/circinterventions.118.006929] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND As transcatheter aortic valve replacement (TAVR) extends its reach to lower surgical risk patients, the differences between resource utilization for TAVR and surgical AVR (SAVR) will become increasingly important. METHODS AND RESULTS AVR procedures between January 2012 and September 2015 at hospitals performing TAVR were identified using the National Inpatient Sample databases. Adults aged ≥50 years with aortic stenosis who underwent isolated TAVR or SAVR were eligible for inclusion. Standardized morbidity ratio weights were calculated using patient demographics, comorbidities, and hospital characteristics. Weighted linear and generalized logistic regression models were used to estimate the effect of undergoing TAVR, compared with undergoing SAVR, on length of stay (LOS) and discharge disposition. In TAVR-performing hospitals, 7266 (40%) patients underwent TAVR (6107 endovascular approach and 1159 transapical approach), while 10 833 (60%) underwent isolated SAVR. Patients undergoing TAVR were older, more likely to be female, and had more comorbidities. From 2012 to 2015, average LOS declined for both TAVR (6.3 days to 4.6 days; P<0.0001) and SAVR (7.5 days to 6.8 days; P<0.0001), with greater reduction in the TAVR group ( P<0.0001). An increase in home/home health discharge was noted with TAVR (67.7%-77.4%; P<0.0001) but not with SAVR (76.8%-79.5%; P=0.25). After standardizing, patients undergoing TAVR had significantly shorter LOS (change in estimate, -2.93, 95% CI, -3.26 to -2.60) and lower incidence of transfer to skilled nursing facility (odds ratio, 0.45; 95% CI, 0.40-0.51) but no difference in in-hospital mortality (odds ratio, 0.85; 95% CI, 0.61-1.20) compared with if they had undergone SAVR. As compared with SAVR, patients who had TAVR performed via an endovascular approach had shorter LOS and lower rates of skilled nursing facility transfer, whereas in the transapical cohort, LOS, and skilled nursing facility transfer were similar to SAVR. CONCLUSIONS As compared with if they undergo SAVR, patients undergoing TAVR (by a nontransapical approach) had a shorter LOS and higher likelihood of home discharge, as opposed to skilled nursing facility. From 2012 to 2015, there was a greater trend towards a reduction of LOS and more home discharges among TAVR, as opposed to SAVR. These data have important implications in the era of constrained resources with a growing emphasis on reducing health care costs.
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Affiliation(s)
- Sameer Arora
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill.,Division of Epidemiology, Gillings School of Public Health (S.A., P.D.S.), University of North Carolina, Chapel Hill
| | - Paula D Strassle
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill.,Division of Surgery (P.D.S., T.G.C.), University of North Carolina, Chapel Hill
| | - Dhaval Kolte
- Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI (D.K.)
| | - Cassandra J Ramm
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill
| | - Kristine Falk
- Department of Internal Medicine (K.F., G.J.), University of North Carolina, Chapel Hill
| | - Godly Jack
- Department of Internal Medicine (K.F., G.J.), University of North Carolina, Chapel Hill
| | - Thomas G Caranasos
- Division of Surgery (P.D.S., T.G.C.), University of North Carolina, Chapel Hill
| | - Matthew A Cavender
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill
| | - Joseph S Rossi
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill
| | - John P Vavalle
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill
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102
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Eng MH, Frisoli TM, Greenbaum AB, Villablanca P, Wang DD, Lee J, O'Neill W. Percutaneous Approaches to the Treatment of Mitral Leaflet Perforation and to Residual Regurgitation After Transcatheter Edge-to-Edge Mitral Valve Repair. Interv Cardiol Clin 2019; 8:383-391. [PMID: 31445722 DOI: 10.1016/j.iccl.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Mitral valve disease becomes more prevalent as the population ages. As the number of percutaneous mitral valve interventions expands, obscure clinical scenarios may emerge and challenge conventional treatment algorithms. Strategies for dealing with complex repairs build on prior experience in mitral perivalvular leak repair. Cases using nitinol- and expanded polytetrafluoroethylene-based devices are used to treat mitral regurgitation in cases of focal mitral perforations and leaks between previously placed mitral valve edge-to-edge devices. This review discusses risks and benefits of performing such complex mitral repairs and informs clinicians of the strengths of weaknesses of different occluder devices in the mitral position.
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Affiliation(s)
- Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
| | - Tiberio M Frisoli
- Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Adam B Greenbaum
- Emory University Hospital, 550 Peachtree Street Northeast, Fl 6, Suite 600, Atlanta, GA 30308, USA
| | - Pedro Villablanca
- Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Dee Dee Wang
- Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - James Lee
- Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - William O'Neill
- Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
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103
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Dawson LP, Dagan M, Koh Y, Duffy SJ, Stub D, Lew P, Shaw JA, Walton A. Factors That Prevent Progression to Transcatheter Aortic Valve Implantation (TAVI). Heart Lung Circ 2019; 28:1225-1234. [DOI: 10.1016/j.hlc.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/14/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022]
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104
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Minkovich LL, Kuiper GJ, Djaiani GN. The “Appropriate Use Criteria” for Treatment and Management of Peripheral Artery Disease: The Anesthesiologist Point of View. J Cardiothorac Vasc Anesth 2019; 33:2118-2122. [DOI: 10.1053/j.jvca.2019.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/11/2022]
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105
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Salemi A, De Micheli A, Aftab A, Elmously A, Chang R, Wong SC, Worku BM. Transcatheter aortic valve replacement in the setting of left atrial appendage thrombus. Interact Cardiovasc Thorac Surg 2019; 27:842-849. [PMID: 29912432 DOI: 10.1093/icvts/ivy189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/13/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Left atrial appendage thrombus (LAT) was an exclusion criterion in the seminal transcatheter aortic valve replacement (TAVR) trials; however, such patients do undergo TAVR in the 'real-world' setting. This study sought to analyse outcomes after TAVR in patients with LAT or spontaneous echo contrast (SEC). METHODS All patients undergoing TAVR at our institution between March 2009 and December 2014 were prospectively analysed. The presence of LAT or SEC was determined via a retrospective chart review. Primary outcomes included 30-day and 1-year neurological events as well as mortality. RESULTS Of the 369 patients undergoing TAVR, 3.8% (14) were found to have LAT and 6.8% (25) were found to have SEC, and they were separately compared to patients who did not have LAT or SEC. Significant differences were noted between groups with regard to preoperative renal function, atrial fibrillation and ejection fraction. Preoperative atrial fibrillation was the only independent predictor of LAT. No perioperative complications were associated with the presence of LAT or SEC. Specifically, no patient with LAT or SEC experienced a postoperative neurological event. While neither LAT nor SEC was an independent predictor of 30-day mortality, LAT was an independent predictor of 1-year mortality (odds ratio 3.573, 95% confidence interval 1.040-12.28; P = 0.042). CONCLUSIONS The current study suggests that TAVR may be performed in patients with LAT and SEC with a low risk of embolic complications. While neither was an independent predictor of 30-day mortality, LAT was an independent predictor of 1-year mortality. Larger studies are needed to better study this phenomenon.
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Affiliation(s)
- Arash Salemi
- Department of Cardiothoracic Surgery, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Andrea De Micheli
- Department of Cardiothoracic Surgery, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Abdullah Aftab
- Department of Cardiothoracic Surgery, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Adham Elmously
- Department of Cardiothoracic Surgery, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Regis Chang
- Department of Cardiac Surgery, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - S Chiu Wong
- Division of Cardiology, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA
| | - Berhane M Worku
- Department of Cardiothoracic Surgery, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA.,Department of Cardiac Surgery, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
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106
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Cozzi O, Regazzoli D, Citterio E, Rossi A, Chiarito M, Stefanini GG, Bragato R, Torracca L, Condorelli G, Pagnotta P, Reimers B. Coral Reef Aorta: A Rare Occlusive Disease of the Aorta Complicating Decision Making for Severe Aortic Stenosis Treatment. Can J Cardiol 2019; 35:940.e13-940.e16. [DOI: 10.1016/j.cjca.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022] Open
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107
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Imágenes cardiovasculares en la valoración del paciente con indicación de implante aórtico transcatéter. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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108
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Tabata N, Sinning JM, Kaikita K, Tsujita K, Nickenig G, Werner N. Current status and future perspective of structural heart disease intervention. J Cardiol 2019; 74:1-12. [DOI: 10.1016/j.jjcc.2019.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
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109
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Endovascular Versus Transapical Transcatheter Aortic Valve Replacement: In-hospital Mortality, Hospital Outcomes, and 30-day Readmission. A Propensity Score-matched Analysis. Crit Pathw Cardiol 2019; 18:102-107. [PMID: 31094738 DOI: 10.1097/hpc.0000000000000180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transapical transcatheter aortic valve replacement (TAVR) is associated with increased morbidity compared with endovascular TAVR. We sought to compare the differences in clinical outcomes between endovascular and transapical TAVR approaches utilizing a propensity score model. METHODS Patients undergoing TAVR (International Classification of Diseases, Ninth Revision, Clinical Modification codes 35.05 and 35.06) between January 2011 and November 2014 were identified in the Nationwide Readmissions Database, and a propensity score-matched analysis was performed comparing transapical versus endovascular approach. The primary outcome of interest was in-hospital mortality and 30-day all-cause readmission. We also evaluated trends in use of TAVR over the years. RESULTS We identified 28,302 endovascular TAVR and 7967 transapical TAVR performed during the study period. The propensity score-matching algorithm yielded 7879 well-matched patients in each group. The in-hospital mortality rates were significantly lower in endovascular TAVR compared with transapical TAVR (1.7% vs 6.7%; OR, 0.24; 95% CI, 0.17- 0.35; P < 0.001). The 30-day readmission rate was lower in endovascular TAVR (14.4% vs 16.8%; OR, 0.83; 95% CI, 0.70-0.98; P = 0.036). Use of TAVR increased from 585 (74% endovascular TAVR) in 2011 to 16,801 in 2014 (82.8% endovascular TAVR). CONCLUSIONS Endovascular TAVR is associated with significantly lower in-patient mortality and lower readmission rate when compared with transapical TAVR. Heart failure remains the most common cause for readmission after TAVR regardless of approach.
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110
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Transcatheter Mitral Valve Therapy: Repair and Replacement. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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111
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Dahle TG, Kaneko T, McCabe JM. Outcomes Following Subclavian and Axillary Artery Access for Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:662-669. [DOI: 10.1016/j.jcin.2019.01.219] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/30/2018] [Accepted: 01/15/2019] [Indexed: 11/24/2022]
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112
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Axillary/Subclavian Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:670-672. [DOI: 10.1016/j.jcin.2019.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 11/21/2022]
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113
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Okoh AK, Kang N, Haik N, Fugar S, Chunguang C, Bruce H, Cohen M, Russo MJ. Clinical and Functional Outcomes Associated with Age after Transapical Transcatheter Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:151-158. [PMID: 30885091 DOI: 10.1177/1556984519836885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Transcatheter aortic valve replacement (TAVR) via a transapical (TA) approach has been associated with high morbidity. The aim of this study is to investigate the association of age and clinical and functional outcomes after TA-TAVR. METHODS Patients who had TA-TAVR at a single center were divided into 3 age groups: <75 years (Group I), 75 to 85 years (Group II), and >85 years (Group III). Pre- and postoperative clinical, functional status, and procedure-related outcomes were compared among patient groups. A multivariable Cox proportional hazards model was used to assess the impact of age on overall all-cause mortality. RESULTS Out of 183 TA-TAVR cases performed, 117 met the study criteria. These included 15 aged <75 years, 60 aged 75 to 85 years, and 42 aged >85 years. Short-term (30-day) clinical and functional status improved significantly for all age groups. The incidence of acute kidney injury, access site complications, and requirement for permanent pacemaker were similar for all age groups at 30 days. After a median follow-up of 26 months, overall all-cause survival rates were 86% for Group I, 88% for Group II, and 83% for Group III at 1 year. Cox proportional hazards model showed frailty status (HR: 1.84; 95% CI, 1.23 to 2.69; P = 0.003) but not age as an independent predictor of overall all-cause mortality. CONCLUSIONS Findings from this study suggest that both older and younger patients benefit from TA-TAVR with comparable operative outcomes. Age should not be an exclusion criterion for TA-TAVR.
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Affiliation(s)
- Alexis Kofi Okoh
- 1 Cardiovascular Research Institute, RWJ Barnabas Health, NBIMC, Newark, NJ, USA
| | - Nathan Kang
- 1 Cardiovascular Research Institute, RWJ Barnabas Health, NBIMC, Newark, NJ, USA
| | - Nicky Haik
- 1 Cardiovascular Research Institute, RWJ Barnabas Health, NBIMC, Newark, NJ, USA
| | - Setri Fugar
- 2 Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Chen Chunguang
- 1 Cardiovascular Research Institute, RWJ Barnabas Health, NBIMC, Newark, NJ, USA
| | - Haik Bruce
- 1 Cardiovascular Research Institute, RWJ Barnabas Health, NBIMC, Newark, NJ, USA
| | - Marc Cohen
- 1 Cardiovascular Research Institute, RWJ Barnabas Health, NBIMC, Newark, NJ, USA
| | - Mark J Russo
- 1 Cardiovascular Research Institute, RWJ Barnabas Health, NBIMC, Newark, NJ, USA
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Overtchouk P, Folliguet T, Pinaud F, Fouquet O, Pernot M, Bonnet G, Hubert M, Lapeze J, Claudel JP, Ghostine S, Azmoun A, Caussin C, Zannis K, Harmouche M, Verhoye JP, Lafont A, Chamandi C, Ruggieri VG, Di Cesare A, Leclercq F, Gandet T, Modine T. Transcarotid Approach for Transcatheter Aortic Valve Replacement With the Sapien 3 Prosthesis. JACC Cardiovasc Interv 2019; 12:413-419. [DOI: 10.1016/j.jcin.2018.11.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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115
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Olds A, George I. Reply. Ann Thorac Surg 2019; 107:1584. [PMID: 30684478 DOI: 10.1016/j.athoracsur.2018.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Anna Olds
- Division of Cardiothoracic Surgery, Columbia University Medical Center, MHB 7GN-435, 177 Fort Washington Ave, New York, NY 10032
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, MHB 7GN-435, 177 Fort Washington Ave, New York, NY 10032.
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116
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Bailey SR, Beckman JA, Dao TD, Misra S, Sobieszczyk PS, White CJ, Wann LS, Bailey SR, Dao T, Aronow HD, Fazel R, Gornik HL, Gray BH, Halperin JL, Hirsch AT, Jaff MR, Krishnamurthy V, Parikh SA, Reed AB, Shamoun F, Shugart RE, Yucel EK. ACC/AHA/SCAI/SIR/SVM 2018 Appropriate Use Criteria for Peripheral Artery Intervention: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, and Society for Vascular Medicine. J Am Coll Cardiol 2019; 73:214-237. [PMID: 30573393 DOI: 10.1016/j.jacc.2018.10.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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117
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Imnadze G, Hofmann S, Billion M, Ferdosi A, Kowalski M, Smith KH, Deutsch C, Bramlage P, Warnecke H, Franz N. Transapical transcatheter aortic valve implantation in patients with a low ejection fraction. Interact Cardiovasc Thorac Surg 2019; 26:224-229. [PMID: 29049741 DOI: 10.1093/icvts/ivx315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES It may be expected that patients with left ventricular dysfunction may be at greater risk of complications after transcatheter aortic valve implantation (TAVI) via transapical (TA) access compared with via transfemoral (TF) access. There is a lack of data comparing the outcomes of TAVI using TA and TF access in patients with a reduced left ventricular ejection fraction (EF). METHODS This is a retrospective analysis of data from a high-volume heart centre in Germany. TAVI access route assignment was based on a 'best for TF' approach, where only patients who met a strict set of criteria underwent TF-TAVI, with the remainder receiving TA-TAVI. For this analysis, patients were included if they had a pre-TAVI EF of ≤ 40%. Early mortality and late (1-year) mortality were compared through multivariate logistic regression. RESULTS A total of 342 patients in the registry had an EF of ≤ 40%, of which 74.9% underwent TA-TAVI and 25.1% underwent TF-TAVI. Higher proportions of the TA group presented with certain comorbidities, and their logistic EuroSCORE and Society of Thoracic Surgeons (STS) risk scores were higher than in the TF group. At 1 year, TA access was associated with greater mortality in the univariate analysis (odd ratio 2.43; 95% confidence interval 1.04-5.69). However, after multivariate adjustment, no significant differences were found in either 30-day or 1-year mortality rates. CONCLUSIONS The data suggest that, for patients with a reduced EF, TA-TAVI is not associated with a poorer outcome compared with TF-TAVI. Therefore, TA access should not be discounted based on the presence of left ventricular dysfunction alone.
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Affiliation(s)
- Guram Imnadze
- Institut für Gesundheitsforschung und Bildung, Universität Osnabrück, Osnabrück, Germany.,Department of Cardiology, Klinikum Osnabrück, Am Finkenhügel 1, Osnabrück, Germany
| | - Steffen Hofmann
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Michael Billion
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Abbas Ferdosi
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Marek Kowalski
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Katherine H Smith
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Henning Warnecke
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany.,Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Norbert Franz
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany.,University Witten-Herdecke, Witten, Germany
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118
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Staniloae CS, Jilaihawi H, Amoroso NS, Ibrahim H, Hisamoto K, Sin DN, Lee H, Du R, Zhao ZG, Neuburger PJ, Williams MR. Systematic Transfemoral Transarterial Transcatheter Aortic Valve Replacement in Hostile Vascular Access. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2018.1556828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Cezar S. Staniloae
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Hasan Jilaihawi
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Nicholas S. Amoroso
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Homam Ibrahim
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Kazuhiro Hisamoto
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Danielle N. Sin
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Hanah Lee
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Run Du
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Zhen-Gang Zhao
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Peter J. Neuburger
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Mathew R. Williams
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
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119
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Schaefer A, Schirmer J, Schofer N, Schneeberger Y, Deuschl F, Blankenberg S, Reichenspurner H, Conradi L, Schäfer U. Transaxillary transcatheter aortic valve implantation utilizing a novel vascular closure device with resorbable collagen material: a feasibility study. Clin Res Cardiol 2018; 108:779-786. [PMID: 30560381 DOI: 10.1007/s00392-018-1407-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/13/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We herein aimed to evaluate technical feasibility of transaxillary (Tax) transcatheter aortic valve implantation (TAVI) utilizing a novel vascular closure device with a resorbable collagen plug and absence of suture material. METHODS Between 05/2018 and 8/2018, eight patients (76.0 ± 5.9 years, 62.5% male, logEuroSCORE I 23.6 ± 4.7) received Tax-TAVI using the MANTA™ vascular closure device. Implanted transcatheter heart valves consisted of Edwards Sapien 3, NVT Allegra, Medtronic CoreValve EvolutR and SJM Portico. RESULTS Puncture location depth was variable (3.5-7.5 cm). The left subclavian artery was used in five cases, the right subclavian artery in three cases. Low-pressure balloon-angioplasty for vessel closure was performed in 5/8 patients. VARC-2 defined device success was met in all patients. Major access site complication occurred in one patient with aneurysma spurium of the subclavian artery and consecutive stent implantation on postoperative day 5. CONCLUSION The MANTA™ device is applicable in Tax-TAVI, with potential particular advantages regarding easiness of use and marked access for subsequent interventions in case of vascular complications. Before conclusions regarding clinical efficacy and safety can be made, the device has to be evaluated in larger patient cohorts.
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Affiliation(s)
- Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Yvonne Schneeberger
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
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Thourani VH, O'Brien SM, Kelly JJ, Cohen DJ, Peterson ED, Mack MJ, Shahian DM, Grover FL, Carroll JD, Brennan JM, Forcillo J, Arnold SV, Vemulapalli S, Fitzgerald S, Holmes DR, Bavaria JE, Edwards FH. Development and Application of a Risk Prediction Model for In-Hospital Stroke After Transcatheter Aortic Valve Replacement: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Ann Thorac Surg 2018; 107:1097-1103. [PMID: 30529671 DOI: 10.1016/j.athoracsur.2018.11.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/30/2018] [Accepted: 11/01/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stroke is a serious complication after transcatheter aortic valve replacement (TAVR), yet predictive models are not available. A new risk model for in-hospital stroke after TAVR was developed and used to estimate site-specific performance. METHODS We included 97,600 TAVR procedures from 521 sites in The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry from July 2014 to June 2017. Association between baseline covariates and in-hospital stroke was estimated by logistic regression. Discrimination was evaluated by C-statistic. Calibration was tested internally via cross-validation. Hierarchical modeling was used to estimate risk-adjusted site-specific performance. RESULTS Median age was 82 years, 44,926 (46.0%) were women, and 1,839 (1.9%) had in-hospital stroke. Covariates associated with stroke (odds ratio) included transapical access (1.44), access excluding transapical and transfemoral (1.77), prior stroke (1.57), prior transient ischemic attack (1.50), preprocedural shock, inotropes or mechanical assist device (1.48), smoking (1.28), porcelain aorta (1.23), peripheral arterial disease (1.21), age per 5 years (1.11), glomerular filtration rate per 5 mL/min (0.97), body surface area per m2 (0.55 male; 0.43 female), and prior aortic valve (0.78) and nonaortic valvular (0.42) procedures. The C-statistic was 0.622. Calibration curves demonstrated agreement between observed and expected stroke rates. Hierarchical modeling showed 10 (1.9%) centers with significantly higher odds ratios for in-hospital stroke than their peers. CONCLUSIONS A risk model for in-hospital stroke after TAVR was developed from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry and used to estimate site-specific stroke performance. This model can serve as a valuable resource for quality improvement, clinical decision making, and patient counseling.
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Affiliation(s)
- Vinod H Thourani
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute and Georgetown University, Washington, DC.
| | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - John J Kelly
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Cohen
- Division of Cardiology, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Michael J Mack
- Heart Hospital Baylor Plano, Baylor Healthcare System, Plano, Texas
| | - David M Shahian
- Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frederick L Grover
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - John D Carroll
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - J Matthew Brennan
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Jessica Forcillo
- Department of Cardiac Surgery, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Suzanne V Arnold
- Division of Cardiology, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | | | | | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph E Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fred H Edwards
- Division of Cardiothoracic Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
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Rogers T, Lederman RJ. Percutaneous transaxillary access for TAVR: Another opportunity to stay out of the chest. Catheter Cardiovasc Interv 2018; 91:157-158. [PMID: 29314639 DOI: 10.1002/ccd.27458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 11/29/2017] [Indexed: 01/06/2023]
Abstract
Axillary arteries are less calcified and tortuous than iliofemoral arteries Axillary artery minimal luminal diameters are usually >5.0 mm even in patients with iliofemoral artery diameters < 5.0 mm Axillary and transcaval access are the only non-surgical fully percutaneous options for large-bore arterial access for TAVR or mechanical circulatory support devices.
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Affiliation(s)
- Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Windecker S, Franzone A, Pilgrim T. Deciphering the Unknowns of Stroke After Aortic Valve Interventions. J Am Coll Cardiol 2018; 72:2427-2430. [PMID: 30442285 DOI: 10.1016/j.jacc.2018.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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123
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Affiliation(s)
- Fabien Praz
- Department of Cardiology, Bern University Hospital, Switzerland (F.P.)
| | - Peter Wenaweser
- Heart Clinic Hirslanden, Hirslanden Clinic Zurich, and Bern University Hospital, Switzerland (P.W.)
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Kumar N, Khera R, Fonarow GC, Bhatt DL. Comparison of Outcomes of Transfemoral Versus Transapical Approach for Transcatheter Aortic Valve Implantation. Am J Cardiol 2018; 122:1520-1526. [PMID: 30190074 DOI: 10.1016/j.amjcard.2018.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
Post hoc analyses of clinical trials have shown superior outcomes for a transfemoral (TF) compared with a transapical (TA) approach for transcatheter aortic valve implantation (TAVI). There are few contemporary data on utilization and outcomes of TF versus TA TAVI in real-world patient populations. Using the National Inpatient Sample 2011 to 2014, we identified TF-TAVI and TA-TAVI procedures using ICD-9 procedure codes 35.05 and 35.06, respectively. A propensity-matched cohort of TF and TA TAVI procedures balanced on 23 baseline characteristics was assembled. Outcomes included in-hospital mortality, acute kidney injury (AKI), AKI requiring dialysis (AKI-D) and postoperative stroke. A total of 7,973 TAVI procedures representative of 39,745 procedures nationally were included in the study. Of these, 80.2% were performed using a TF approach while 19.8% used a TA approach. Patients in the TF-TAVI group were older (mean age 81.7 vs 80.4 years, p < 0.001), with a higher prevalence of heart failure (12.7% vs 7.6%, p < 0.001) and lower prevalence of peripheral vascular disease (28.0% vs 35.5%, p < 0.001) compared with the TA-TAVI group. In 1,576 propensity-matched pairs of TF-TAVI and TA-TAVI procedures, TF-TAVI was associated with significantly lower in-hospital mortality (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.42 to 0.88, p = 0.01), lower rates of AKI (0.53, 95% CI 0.44 to 0.63, p < 0.001), similar rates of AKI-D (OR 0.77, 95% CI 0.44 to 1.38, p = 0.38) and postoperative stroke (OR 1.19, 95% CI 0.67 to 2.10, p = 0.56) compared with TA-TAVI. In conclusion, TF-TAVI is associated with lower rates of in-hospital mortality and AKI compared with TA-TAVI. A TF approach should be preferred over a TA approach for TAVI whenever possible.
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Chamandi C, Abi-Akar R, Rodés-Cabau J, Blanchard D, Dumont E, Spaulding C, Doyle D, Pagny JY, DeLarochellière R, Lafont A, Paradis JM, Puri R, Karam N, Maes F, Rodriguez-Gabella T, Chassaing S, Le Page O, Kalavrouziotis D, Mohammadi S. Transcarotid Compared With Other Alternative Access Routes for Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2018; 11:e006388. [DOI: 10.1161/circinterventions.118.006388] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chekrallah Chamandi
- Department of Cardiac Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G., D.K., S.M.)
| | - Ramzi Abi-Akar
- Department of Cardiac Surgery and Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, France (R.A.-A., D.B., C.S., J.-Y.P., A.L., N.K.)
| | - Josep Rodés-Cabau
- Department of Cardiac Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G., D.K., S.M.)
| | - Didier Blanchard
- Department of Cardiac Surgery and Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, France (R.A.-A., D.B., C.S., J.-Y.P., A.L., N.K.)
| | - Eric Dumont
- Department of Cardiac Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G., D.K., S.M.)
| | - Christian Spaulding
- Department of Cardiac Surgery and Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, France (R.A.-A., D.B., C.S., J.-Y.P., A.L., N.K.)
| | - Daniel Doyle
- Department of Cardiac Surgery and Cardiology, Clinique St Gatien, Tours, France (D.B., S.C., O.L.P.)
| | - Jean-Yves Pagny
- Department of Cardiac Surgery and Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, France (R.A.-A., D.B., C.S., J.-Y.P., A.L., N.K.)
| | - Robert DeLarochellière
- Department of Cardiac Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G., D.K., S.M.)
| | - Antoine Lafont
- Department of Cardiac Surgery and Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, France (R.A.-A., D.B., C.S., J.-Y.P., A.L., N.K.)
| | - Jean-Michel Paradis
- Department of Cardiac Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G., D.K., S.M.)
| | - Rishi Puri
- Department of Cardiac Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G., D.K., S.M.)
| | - Nicole Karam
- Department of Cardiac Surgery and Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, France (R.A.-A., D.B., C.S., J.-Y.P., A.L., N.K.)
| | - Frédéric Maes
- Department of Cardiac Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G., D.K., S.M.)
| | - Tania Rodriguez-Gabella
- Department of Cardiac Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G., D.K., S.M.)
| | - Stéphan Chassaing
- Department of Cardiac Surgery and Cardiology, Clinique St Gatien, Tours, France (D.B., S.C., O.L.P.)
| | - Olivier Le Page
- Department of Cardiac Surgery and Cardiology, Clinique St Gatien, Tours, France (D.B., S.C., O.L.P.)
| | - Dimitri Kalavrouziotis
- Department of Cardiac Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G., D.K., S.M.)
| | - Siamak Mohammadi
- Department of Cardiac Surgery and Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (C.C., J.R.-C., E.D., D.D., R.D., J.-M.P., R.P., F.M., T.R.-G., D.K., S.M.)
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Iluyomade A, Cohen MG. Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2018; 11:e007169. [PMID: 30354602 DOI: 10.1161/circinterventions.118.007169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adedapo Iluyomade
- Cardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine, FL
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine, FL
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McKiernan M, Lisko J, Grubb KJ. Alternative TAVR Access: Is It Time to Alter Your Alternative Access Strategy? Semin Thorac Cardiovasc Surg 2018; 31:181-182. [PMID: 30359731 DOI: 10.1053/j.semtcvs.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Maureen McKiernan
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John Lisko
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Kendra J Grubb
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
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128
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Long-Term Outcomes of Iliofemoral Artery Stents after Transfemoral Aortic Valve Replacement. J Vasc Interv Radiol 2018; 29:1733-1740. [PMID: 30297312 DOI: 10.1016/j.jvir.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To report long-term results of iliofemoral stent placement after transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS TAVR access-related complications treated with iliofemoral stent placement were recorded in 56 patients (mean age, 81 years; range; 53-93 years; 48% male) of 648 patients who underwent TAVR at a single center. Fifty-six patients treated with stent placement (40 patients with stent grafts and 16 patients with bare metal stents) underwent clinical and ultrasonographic follow-up after a mean of 676 days (range, 60-1840 days). RESULTS During follow-up, none of the 56 patients who had stent placement underwent a vascular reintervention of the affected limb, and none suffered from limb claudication. No decrease was observed in ankle-brachial index (ABI) values to an abnormal value, except in 1 patient (mean preprocedural and postprocedural ABI of 1.2 ± 0.14, range, 0.97-1.4 and 1.19 ± 0.24, range, 0.65-1.54, respectively). Arterial duplex assessment showed normal stent flow velocity (mean, 168.7 ± 63.2 cm/sec; range, 80-345 cm/sec) in all but 1 patient. CONCLUSION Iliofemoral stent implantation is a safe and efficacious treatment for vascular access site and access-related complications during transfemoral TAVR.
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Overtchouk P, Modine T. A comparison of alternative access routes for transcatheter aortic valve implantation. Expert Rev Cardiovasc Ther 2018; 16:749-756. [DOI: 10.1080/14779072.2018.1524295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Pavel Overtchouk
- Interventional Cardiology and Cardiovascular Surgery Centre Hospitalier Regional, Universitaire de Lille (CHRU de Lille), Lille, France
| | - Thomas Modine
- Interventional Cardiology and Cardiovascular Surgery Centre Hospitalier Regional, Universitaire de Lille (CHRU de Lille), Lille, France
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Refining indications and access in transcatheter mitral valve-in-valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:814-815. [PMID: 30236625 DOI: 10.1016/j.carrev.2018.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW This report aims to define the clinical and anatomic variables key in determining patient suitability for transcatheter mitral valve therapies. RECENT FINDINGS Candidacy for transcatheter mitral valve repair requires weighing the clinical variables that may impact the ability to improve patient symptoms and prolong survival that include left ventricular ejection fraction, symptom severity, pulmonary hypertension, and magnitude of residual regurgitation or stenosis. Individualized selection of transcatheter repair or replacement based on patho-anatomy is being explored. The primary goal is achieving significant reduction in mitral regurgitation. Transcatheter mitral valve replacement requires rigorous anatomic screening using computed tomography and candidates should be able to take oral anticoagulation. Selection of patients for transcatheter mitral valve repair is complex and requires intimate knowledge of clinical variables and specific device limitations.
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132
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Lanz J, Greenbaum A, Pilgrim T, Tarantini G, Windecker S. Current state of alternative access for transcatheter aortic valve implantation. EUROINTERVENTION 2018; 14:AB40-AB52. [DOI: 10.4244/eij-d-18-00552] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rogers T, Gai J, Torguson R, Okubagzi PG, Shults C, Ben-Dor I, Satler LF, Waksman R. Predicted magnitude of alternate access in the contemporary transcatheter aortic valve replacement era. Catheter Cardiovasc Interv 2018; 92:964-971. [DOI: 10.1002/ccd.27668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/02/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
- Cardiovascular Branch, Division of Intramural Research; National Heart Lung and Blood Institute, National Institutes of Health; Bethesda Maryland
| | - Jiaxiang Gai
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Petros G. Okubagzi
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Christian Shults
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
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A Review of Alternative Access for Transcatheter Aortic Valve Replacement. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:62. [PMID: 29974264 DOI: 10.1007/s11936-018-0648-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
With the advent of transcatheter aortic valve replacement (TAVR), appropriately selected intermediate-, high-, and extreme-risk patients with severe aortic stenosis (AS) are now offered a less invasive option compared to conventional surgery. In contemporary practice, TAVR is performed predominantly via a transfemoral arterial approach, whereby a transcatheter heart valve (THV) is delivered in a retrograde fashion through the iliofemoral arterial system and thoraco-abdominal aorta, into the native aortic valve annulus. While the majority of patients possess suitable anatomy for transfemoral arterial access, there is a subset of patients with extensive peripheral vascular disease that precludes this traditional approach to TAVR. Fortunately, innovation in the field of structural heart disease has led to the refinement of alternative access options for THV delivery. Selection of the most appropriate route of therapy mandates a careful consideration of multiple factors, including patient anatomy, technical feasibility, and equipment specifications. Furthermore, understanding the risks conferred by each access site for valve delivery-notably stroke, vascular injury, and major bleeding-is of paramount importance when selecting the approach that will best optimize the outcome for an individual. In this review, we provide a comprehensive summary of alternative approaches to transfemoral arterial TAVR as well as the available outcome data supporting each of these various techniques.
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135
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Amat-Santos IJ, Cortés C, Nombela Franco L, Muñoz-García AJ, Suárez De Lezo J, Gutiérrez-Ibañes E, Serra V, Larman M, Moreno R, De La Torre Hernandez JM, Puri R, Jimenez-Quevedo P, Hernández García JM, Alonso-Briales JH, García B, Lee DH, Rojas P, Sevilla T, Goncalves R, Vera S, Gómez I, Rodés-Cabau J, San Román JA. Prosthetic Mitral Surgical Valve in Transcatheter Aortic Valve Replacement Recipients: A Multicenter Analysis. JACC Cardiovasc Interv 2018; 10:1973-1981. [PMID: 28982562 DOI: 10.1016/j.jcin.2017.07.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prognosis and specific complications of patients with prosthetic mitral valves (PMVs) undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND TAVR is performed relatively often in patients with PMVs, but specific risks are not well described. METHODS A multicenter analysis was conducted, including patients with severe symptomatic aortic stenosis who underwent TAVR at 10 centers. Patients' clinical characteristics and outcomes were evaluated according to the presence of a PMV. RESULTS The mean age of the study population (n = 2,414) was 81 ± 8 years, and 48.8% were men. A total of 91 patients (3.77%) had PMVs. They were more commonly women, younger, and had higher surgical risk. PMVs were implanted a median of 14 years before TAVR, and most patients had mechanical prostheses (73.6%). Eighty-six patients (94.5%) were on long-term vitamin K inhibitor therapy, and bridging antithrombotic therapy was administered in 59 (64.8%). TAVR device embolization occurred in 6.7% (vs. 3.3% in the non-PMV group; p = 0.127), in all instances when distance between the PMV and the aortic annulus was <7 mm. Mortality rates did not show a difference, but the rate of bleeding was higher in patients with PMV (24.2% vs. 16.1%; p = 0.041), even in those treated via the transfemoral approach (22.2% vs. 13.9%; p = 0.048). Indeed, bleeding complications, prior atrial fibrillation, chronic obstructive pulmonary disease, surgical risk, and New York Heart Association functional class were independent predictors of mortality. CONCLUSIONS TAVR presents similar mortality irrespective of the presence of a PMV. However, patients with PMVs had higher bleeding risk that was independently associated with higher mortality. Risk for valve embolization was relatively high, but it occurred only in patients with PMV-to-aortic annulus distances <7 mm.
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Affiliation(s)
| | - Carlos Cortés
- Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | | | | | - Vicenç Serra
- Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | | | - Raúl Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | - Rishi Puri
- Institute Universitaire de Cardiologie et Pneumologie de Quebec, Ville de Québec, Québec, Canada; Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio
| | | | | | | | - Bruno García
- Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Dae-Hyun Lee
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Paol Rojas
- Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
| | - Teresa Sevilla
- CIBERCV, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Silvio Vera
- Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
| | - Itziar Gómez
- CIBERCV, Hospital Clínico Universitario, Valladolid, Spain
| | - Josep Rodés-Cabau
- Institute Universitaire de Cardiologie et Pneumologie de Quebec, Ville de Québec, Québec, Canada
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Fanaroff AC, Manandhar P, Holmes DR, Cohen DJ, Harrison JK, Hughes GC, Thourani VH, Mack MJ, Sherwood MW, Jones WS, Vemulapalli S. Peripheral Artery Disease and Transcatheter Aortic Valve Replacement Outcomes: A Report From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Therapy Registry. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005456. [PMID: 29042398 DOI: 10.1161/circinterventions.117.005456] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with increased cardiovascular mortality, and PAD risk factors overlap with those for aortic stenosis. The prevalence and outcomes associated with PAD in a population undergoing transcatheter aortic valve replacement (TAVR) are unknown. METHODS AND RESULTS Using the Society of Thoracic Surgeons/Transcatheter Valve Therapy Registry linked to Medicare claims data, we identified patients ≥65 years old undergoing TAVR from 2011 to 2015. We calculated hazard ratios for 1-year adverse outcomes, including mortality, readmission, and bleeding, for patients with PAD compared with those without, adjusting for baseline characteristics and postprocedure medications. Analyses were performed separately by access site (transfemoral and nontransfemoral). Of 19 660 patients undergoing transfemoral TAVR, 4810 (24.5%) had PAD; 3730 (47.9%) of 7780 patients undergoing nontransfemoral TAVR had PAD. In both groups, patients with PAD were significantly more likely to have coronary and carotid artery diseases. At 1-year follow-up, patients with PAD undergoing TAVR via transfemoral access had a higher incidence of death (16.8% versus 14.4%; adjusted hazard ratio, 1.14; P=0.01), readmission (45.5% versus 42.1%; hazard ratio, 1.11; P<0.001), and bleeding (23.1% versus 19.7%; hazard ratio, 1.18; P<0.001) compared with patients without PAD. Patients with PAD undergoing TAVR via nontransfemoral access did not have significantly higher rates of 1-year mortality or readmission compared with patients without PAD. CONCLUSIONS PAD is common among patients undergoing commercial TAVR via transfemoral and nontransfemoral access. Among patients undergoing transfemoral TAVR, PAD is associated with a higher incidence of 1-year adverse outcomes compared with absence of PAD. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01737528.
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Affiliation(s)
- Alexander C Fanaroff
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.).
| | - Pratik Manandhar
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - David R Holmes
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - David J Cohen
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - J Kevin Harrison
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - G Chad Hughes
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Vinod H Thourani
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Michael J Mack
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Matthew W Sherwood
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - W Schuyler Jones
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Sreekanth Vemulapalli
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
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Kolte D, Khera S, Vemulapalli S, Dai D, Heo S, Goldsweig AM, Aronow HD, Elmariah S, Inglessis I, Palacios IF, Thourani VH, Sharaf BL, Gordon PC, Abbott JD. Outcomes Following Urgent/Emergent Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:1175-1185. [DOI: 10.1016/j.jcin.2018.03.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
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Transcatheter aortic valve replacement: current state of development. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-018-0654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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139
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Transcaval Valve-in-Valve-in-Valve Aortic Valve Replacement for Bioprosthetic Valve Degeneration. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:132-135. [PMID: 29668501 DOI: 10.1097/imi.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 74-year-old man presented with progressive dyspnea on exertion. History included peripheral arterial disease and coronary artery bypass grafting with aortic valve replacement 12 years ago. Subsequently, the surgical valve developed severe stenosis and moderate insufficiency. He underwent a transapical valve-in-valve transcatheter aortic valve replacement 5 years before presentation. This second valve developed a mean gradient of 66 mm Hg with mild insufficiency. The patient was treated with a third aortic valve using an alternative transcaval approach, significantly alleviating his symptoms.
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Greason KL, Eleid MF, Nkomo VT, King KS, Williamson EE, Sandhu GS, Holmes DR. Predictors of 1-year mortality after transcatheter aortic valve replacement. J Card Surg 2018; 33:243-249. [DOI: 10.1111/jocs.13574] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kevin L. Greason
- Department of Cardiovascular Surgery; Mayo Clinic; Rochester Minnesota
| | - Mackram F. Eleid
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Katherine S. King
- Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | | | | | - David R. Holmes
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
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141
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Transcatheter Aortic Valve Replacement by a Novel Suprasternal Approach. Ann Thorac Surg 2018; 105:1215-1222. [DOI: 10.1016/j.athoracsur.2017.10.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/25/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022]
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Doshi R, Shah P, Meraj PM. In-hospital outcomes comparison of transfemoral vs transapical transcatheter aortic valve replacement in propensity-matched cohorts with severe aortic stenosis. Clin Cardiol 2018; 41:326-332. [PMID: 29573452 DOI: 10.1002/clc.22866] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is the preferred option for high-risk patients with severe aortic stenosis. The preferred access for TAVR is transfemoral (TF). Alternatives include the transapical (TA), trans-subclavian (TS), and direct aortic (TAo) approaches. HYPOTHESIS The TF approach is associated with lower in-hospital outcomes as well as shorter length of stay and lower cost of hospitalization. METHODS The National Inpatient Sample database from 2012 through 2014 was used to obtain the TAVR study population. International Classification of Diseases, 9th Revision, Clinical Modification procedure codes were utilized to identify the 2 groups. In-hospital outcomes were compared in propensity-score-matched (1:3) cohorts, in which we took TA-TAVR as a control. RESULTS A total of 8210 (weighted N = 41 050) patients were identified. Of these, 1622 (weighted N = 8110) patients underwent TA-TAVR and 6588 (weighted N = 32 940) patients underwent TF-TAVR. In-hospital mortality was lower with TF-TAVR (4% vs 5.4%; P = 0.0355), along with a shorter length of stay (7.7 vs 9.7 days; P < 0.0001) and lower median hospitalization cost ($64 216 vs $74 735; P < 0.0001). Secondary outcomes of acute renal failure, transfusion, cardiogenic shock, and composite of all complications were lower with TF-TAVR. CONCLUSIONS TF-TAVR is safer and associated with lower in-hospital outcomes compared with TA-TAVR and should be the preferred approach. As TAVR is gaining popularity in intermediate- and low-risk patients, we must not lose sight of the serious mortality and secondary outcomes associated with TA-TAVR access.
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Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Priyank Shah
- Department of Cardiology, Medical College of Georgia-Southwest Clinical Campus, Albany, Georgia
| | - Perwaiz M Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
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143
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Watkins AC, Devireddy CM, Al-Atassi T, Simone AE, Forcillo J, Thourani VH. Transcaval Valve-in-Valve-in-Valve Aortic Valve Replacement for Bioprosthetic Valve Degeneration. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Claire Watkins
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA USA
| | - Chandan M. Devireddy
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, GA USA
| | - Talal Al-Atassi
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON Canada
| | - Amy E. Simone
- Piedmont Healthcare, Marcus Heart Valve Center, Atlanta, GA USA
| | - Jessica Forcillo
- Department of Cardiac Surgery, Universitέ de Montrέal, Montrέal, PQ Canada
| | - Vinod H. Thourani
- Medstar Heart and Vascular Institute, Washington Hospital Center, Washington, DC USA
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Baldus S, Kuck KH, Rudolph V, Nef H, Eggebrecht H, Boekstegers P, Wöhrle J, Ince H, Möllmann H, Stellbrink C, Hausleiter J, v. Bardeleben S, Kelm M, Elsässer A. Interventionelle Therapie von AV-Klappenerkrankungen – Fokus Mitralklappeninsuffizienz. KARDIOLOGE 2018. [DOI: 10.1007/s12181-018-0232-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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145
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Gleason TG, Schindler JT, Hagberg RC, Deeb GM, Adams DH, Conte JV, Zorn GL, Hughes GC, Guo J, Popma JJ, Reardon MJ. Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve Replacement Renders Equivalent Outcomes as Transfemoral. Ann Thorac Surg 2018; 105:477-483. [DOI: 10.1016/j.athoracsur.2017.07.017] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/04/2017] [Accepted: 07/10/2017] [Indexed: 11/24/2022]
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146
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Transapical approach in transcatheter cardiovascular interventions. Gen Thorac Cardiovasc Surg 2018; 66:185-191. [DOI: 10.1007/s11748-018-0890-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/17/2018] [Indexed: 11/27/2022]
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147
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Transcatheter aortic valve implantation at a high-volume center: the Bad Rothenfelde experience. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 14:215-224. [PMID: 29354172 PMCID: PMC5767770 DOI: 10.5114/kitp.2017.72224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/23/2017] [Indexed: 11/20/2022]
Abstract
Introduction The “transfemoral (TF) first” approach to access route selection in transcatheter aortic valve implantation (TAVI) is popular; however, the risk of major vascular complications is substantial. The “best for TF” approach identifies only the patients with ideal anatomy for TF-TAVI, potentially minimizing complications. Aim To characterize the outcomes of patients undergoing TAVI at a large-volume site that employs this approach. Material and methods Patients who underwent TAVI at the Bad Rothenfelde Heart Centre between 2008 and 2016 were consecutively enrolled. Findings were compared to those from large, multicenter registries. Results Of the 1,644 patients enrolled, 1,140 underwent TA- and 504 TF-TAVI. Comorbidities were more frequent in TA patients, who also had higher risk scores (EuroSCORE: 25.5% vs. 21.2%; STS score: 11.0% vs. 7.5%; p < 0.001 for both). Rates of conversion to open surgery, major vascular complications and intra-procedural mortality did not differ between groups. At 30 days, mortality rates were higher in the TA group (3.9% vs. 1.9%, p = 0.036). Stroke/transient ischemic attack and permanent pacemaker implantation rates did not differ significantly between groups (2.0% and 9.1% overall, respectively). Compared to multicenter registries, trends in mortality and complication rates were similar, though magnitudes were lower in the present study. In contrast with the present study, major vascular complication rates in multicenter registries are significantly higher for TF compared to TA patients. Conclusions At this high-volume center, the use of a “best for TF” approach to TAVI resulted in low mortality and complication rates.
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148
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Kolkailah AA, Hirji SA, Ejiofor JI, Ramirez Del Val F, Lee J, Norman AV, McGurk S, Mahmood S, Shook D, Vlassakov K, Nyman CB, Shah P, Pelletier MP, Kaneko T. Novel fast-track recovery protocol for alternative access transcatheter aortic valve replacement: application to non-femoral approaches. Interact Cardiovasc Thorac Surg 2018; 26:938-943. [DOI: 10.1093/icvts/ivx409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/26/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ahmed A Kolkailah
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sameer A Hirji
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Julius I Ejiofor
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Fernando Ramirez Del Val
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jiyae Lee
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony V Norman
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Siobhan McGurk
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sadiqa Mahmood
- Department of Quality, Safety and Value, Partners Healthcare, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas Shook
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kamen Vlassakov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Pinak Shah
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc P Pelletier
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Van Hemelrijck M, Taramasso M, De Carlo C, Kuwata S, Regar E, Nietlispach F, Ferrero A, Weber A, Maisano F. Recent advances in understanding and managing aortic stenosis. F1000Res 2018; 7:58. [PMID: 29375823 PMCID: PMC5770996 DOI: 10.12688/f1000research.11906.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 11/20/2022] Open
Abstract
Over the last few years, treatment of severe symptomatic aortic stenosis in high-risk patients has drastically changed to adopt a less-invasive approach. Transcatheter aortic valve implantation (TAVI) has been developed as a very reproducible and safe procedure, as shown in many trials. When compared to surgery, TAVI has produced superior, or at least comparable, results, and thus a trend to broaden treatment indications to lower-risk patients has erupted as a natural consequence, even though there is a lack of long-term evidence. In this review, we summarize and underline aspects that still remain unanswered that are compulsory if we want to enhance our understanding of this disease.
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Affiliation(s)
- Mathias Van Hemelrijck
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Carlotta De Carlo
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Shingo Kuwata
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Evelyn Regar
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Adolfo Ferrero
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Alberto Weber
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
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Abstract
Transcatheter aortic valve implantation (TAVI) is currently performed through an alternative access in 15% of patients. The transapical access is progressively being abandoned as a result of its invasiveness and poor outcomes. Existing data does not allow TAVI operators to favour one access over another - between transcarotid, trans-subclavian and transaortic - because all have specific strengths and weaknesses. The percutaneous trans-subclavian access might become the main surgery-free alternative access, although further research is needed regarding its safety. Moreover, the difficult learning curve might compromise its adoption. The transcaval access is at an experimental stage and requires the development of dedicated cavo-aortic crossing techniques and closure devices.
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Affiliation(s)
- Pavel Overtchouk
- Centre Hospitalier Regional et Universitaire de Lille Lille, France
| | - Thomas Modine
- Centre Hospitalier Regional et Universitaire de Lille Lille, France
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