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Gennari M, Biroli M, Severgnini G, Olivares P, Ferrari C, Giacari CM, Agrifoglio M, De Marco F, Taramasso M. The PIGTAIL paradigm for a fast and safe transfemoral transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2024. [PMID: 38773853 DOI: 10.1002/ccd.31090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/03/2024] [Accepted: 05/08/2024] [Indexed: 05/24/2024]
Abstract
Transfemoral transcatheter aortic valve replacement is the preferred primary access route whenever possible. Despite advancements in expertise and delivery system profiles, complications associated with the primary femoral access still significantly affect procedural morbidity and outcomes. The current standard for accurate main access planning involves proper preprocedural evaluation guided by computed tomography. Several baseline clinical and anatomical features serve as predictors for the risk of vascular injury occurring during or after transcatheter aortic valve replacement. In this paper, we aimed at reviewing the most up-to-date knowledge of the topic for a safe transfemoral access approach according to a paradigm we have called "PIGTAIL."
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Affiliation(s)
- Marco Gennari
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
| | - Matteo Biroli
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
- University of Milan, Milan, Italy
| | - Gaia Severgnini
- University of Milan, Milan, Italy
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Paolo Olivares
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
| | - Cristina Ferrari
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
| | - Carlo Maria Giacari
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
| | - Marco Agrifoglio
- University of Milan, Milan, Italy
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Federico De Marco
- IRCCS Centro Cardiologico Monzino, Interventional, Valvular and Structural Heart Cardiology, Milan, Italy
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Kaluski E, Khan SU, Sattur S, Sporn D, Rogers G, Reitknecht F. Arteriotomy site complication during transcatheter aortic valve replacement: Ipsilateral wire protection and bailout. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018. [DOI: 10.1016/j.carrev.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kobayashi A, Lazkani M, Moualla S, Orazio A, Tasset M, Morris M, Fang K, Pershad A. Impact of aortic aneurysms in trans-catheter aortic valve replacement: A single center experience. Indian Heart J 2018; 70 Suppl 3:S303-S308. [PMID: 30595280 PMCID: PMC6309288 DOI: 10.1016/j.ihj.2018.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 04/22/2018] [Accepted: 06/25/2018] [Indexed: 11/29/2022] Open
Abstract
Background Patients who undergo trans-catheter aortic valve replacement (TAVR) may have concomitant aortic aneurysms. We sought to clarify the incidence of aortic aneurysms and its impact on clinical outcomes among patients undergoing TAVR. Methods We performed a retrospective analysis of patients with severe symptomatic aortic stenosis who underwent TAVR from January 2012 to June 2016. Multi-detector computer tomography (MDCT) was performed on all patients and images were reviewed to identify thoracic and abdominal aortic aneurysms (TAA and AAA). The incidence of vascular complications (VARC-2 definition), and in-hospital and 6-month major adverse cardiac events (MACE) defined as a composite of all-cause mortality, cardiac arrest, myocardial infarction, and stroke were recorded. Results Among 232 patients included in the analysis, 22 patients (9.5%) had aortic aneurysms (11 had AAA, 8 had TAA, and 3 had both). Patients with aortic aneurysms had a higher, albeit statistically insignificant, rate of smoking history (63.6% vs. 42.9%, p = 0.062). Both groups of patient predominantly underwent TAVR via trans-femoral access (72.7% vs. 71.4%, p = 0.90). The incidence of vascular complications was similar between the two groups (9.1% vs. 10.5%, p = 1.0). Patients with aortic aneurysms had a similar in-hospital MACE (4.5% vs. 6.2%, p = 1.0) and 6-month MACE (9.1% vs. 9.0%, p = 1.0) compared to those without aneurysms. Conclusions In our patient cohort, 9.5% of patients who underwent TAVR had concomitant aortic aneurysms. Patients with aortic aneurysms had similar incidence of vascular complications as well as in-hospital and 6-month MACE compared to those without.
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Affiliation(s)
| | - Mohamad Lazkani
- Banner University Medical Center, Division of Cardiology, USA
| | - Soundos Moualla
- Banner University Medical Center, Division of Cardiology, USA
| | - Amabile Orazio
- Banner University Medical Center, Division of Cardiac Surgery, USA
| | - Mark Tasset
- Banner University Medical Center, Division of Cardiac Surgery, USA
| | - Michael Morris
- Banner University Medical Center, Division of Radiology, USA
| | - Kenith Fang
- Banner University Medical Center, Division of Cardiac Surgery, USA
| | - Ashish Pershad
- Banner University Medical Center, Division of Cardiology, USA
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Barbanti M, Gulino S, Costa G, Tamburino C. Optimization and simplification of transcatheter aortic valve implantation therapy. Expert Rev Cardiovasc Ther 2018; 16:287-296. [PMID: 29508624 DOI: 10.1080/14779072.2018.1449644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is now a widely adopted therapy for the treatment of elderly patients with severe aortic stenosis. Improved pre-procedural screening, increased operators' experience and technology advancement have made this technique highly reliable and standardized. Areas covered: The purpose of this review article is to provide an overview of the strategies that can be adopted to optimize the TAVI procedure (pre-interventional work-up and procedural simplification and early discharge). Expert commentary: Optimization of TAVI therapy is already a reality and has shown to be safe in most patients, but its penetration has to face with real-world practice. The adoption of a minimalistic and optimized approach requires integration of multidisciplinary competences and an extended, dynamic conception of heart team, which also includes patients' families, referring cardiologist and general practitioners.
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Affiliation(s)
- Marco Barbanti
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Simona Gulino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Giuliano Costa
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Corrado Tamburino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
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Perrin N, Ellenberger C, Licker M, Hachulla AL, Cikirikcioglu M, Frei A, Roffi M, Noble S. Management of vascular complications following transcatheter aortic valve implantation. Arch Cardiovasc Dis 2016; 108:491-501. [PMID: 26073229 DOI: 10.1016/j.acvd.2015.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/13/2015] [Accepted: 03/19/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vascular complications (VCs) after transcatheter aortic valve implantation (TAVI) are frequent and their management is challenging. AIM To report the incidence, predictors and management of VCs following percutaneous transfemoral TAVI (TF-TAVI) at a single centre. METHODS We analyzed 102 consecutive patients who underwent percutaneous TF-TAVI between August 2008 and December 2013. All endpoints were evaluated at 30 days and 6 months according to Valve Academic Research Consortium-2 criteria. VC percutaneous treatment success was defined as residual stenosis<30%, absence of blood extravasation and absence of surgical or repeat endovascular intervention at 30 days. RESULTS Twenty-two patients (22%) experienced VCs, including five patients (5%) with major VCs. Mortality at 30 days was significantly higher in patients with major VCs than in patients without major VCs (60% vs 3%; P=0.001). Patients with VCs had more life-threatening or major bleeding (23% vs 5%; P=0.02), but no difference in terms of need for blood transfusion was observed. Endovascular treatment was used in 13 of 22 patients with VCs (59%) and was successful in 11 of these 13 patients (85%). Primary surgical repair was necessary in only 1/22 (5%) patients, for a common femoral artery pseudoaneurysm 2 weeks after the TAVI procedure. CONCLUSIONS VCs following TF-TAVI are frequent. Major but not minor VCs are associated with increased mortality. Percutaneous management of VCs is feasible and safe, and surgery is rarely needed.
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Affiliation(s)
- Nils Perrin
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
| | | | - Marc Licker
- Anaesthesiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Anne-Lise Hachulla
- Radiology Department, University Hospital of Geneva, Geneva, Switzerland
| | | | - Angela Frei
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Marco Roffi
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Stéphane Noble
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
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García E, Unzué L, Martín-Hernández P, Hernández-Antolín RA. Implicaciones del sellado vascular en el implante percutáneo transfemoral de válvula aórtica. Respuesta. Rev Esp Cardiol (Engl Ed) 2014. [DOI: 10.1016/j.recesp.2014.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Implicaciones del sellado vascular en el implante percutáneo transfemoral de válvula aórtica. Rev Esp Cardiol (Engl Ed) 2014. [DOI: 10.1016/j.recesp.2014.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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García E, Unzué L, Martín-Hernández P, Hernández-Antolín RA. Vascular sealing implications in transfemoral transcatheter aortic valve implantation. Response. ACTA ACUST UNITED AC 2014; 67:870. [PMID: 25205648 DOI: 10.1016/j.rec.2014.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/23/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Eulogio García
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - Leire Unzué
- Servicio de Cardiología, Hospital Universitario Madrid-Montepríncipe, Madrid, Spain
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Vascular sealing implications in transfemoral transcatheter aortic valve implantation. ACTA ACUST UNITED AC 2014; 67:869. [PMID: 25155346 DOI: 10.1016/j.rec.2014.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 11/21/2022]
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Greason KL, Suri RM, Huebner M, Reeder GS, Williamson EE, Nkomo VT, Rihal CS, Mathew V. Vascular Access Site Injury After Transfemoral Transcatheter Aortic Valve Insertion. J Card Surg 2013; 28:348-52. [DOI: 10.1111/jocs.12140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kevin L. Greason
- Division of Cardiovascular Surgery, Department of Surgery; Mayo Clinic; Rochester Massachusetts
| | - Rakesh M. Suri
- Division of Cardiovascular Surgery, Department of Surgery; Mayo Clinic; Rochester Massachusetts
| | - Marianne Huebner
- Department of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | - Guy S. Reeder
- Division of Cardiovascular Diseases, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | | | - Vuyisile T. Nkomo
- Division of Cardiovascular Diseases, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Charanjit S. Rihal
- Division of Cardiovascular Diseases, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Verghese Mathew
- Division of Cardiovascular Diseases, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
- Department of Diagnostic Radiology; Mayo Clinic; Rochester Minnesota
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