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Rooijakkers MJP, Versteeg GAA, Hemelrijk KI, Aarts HM, Overduin DC, van Ginkel DJ, Vlaar PJ, van Wely MH, van Nunen LX, van Geuns RJ, van Garsse LAFM, Geuzebroek GSC, Verkroost MWA, Rodwell L, Heijmen RH, Tonino PAL, Ten Berg JM, Delewi R, van Royen N. Upper extremity versus lower extremity for secondary access during transcatheter aortic valve implantation: rationale and design of the randomised TAVI XS trial. Neth Heart J 2024; 32:270-275. [PMID: 38653922 PMCID: PMC11239632 DOI: 10.1007/s12471-024-01869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND During transcatheter aortic valve implantation (TAVI), secondary access is required for angiographic guidance and temporary pacing. The most commonly used secondary access sites are the femoral artery (angiographic guidance) and the femoral vein (temporary pacing). An upper extremity approach using the radial artery and an upper arm vein instead of the lower extremity approach using the femoral artery and femoral vein may reduce clinically relevant secondary access site-related bleeding complications, but robust evidence is lacking. TRIAL DESIGN The TAVI XS trial is a multicentre, randomised, open-label clinical trial with blinded evaluation of endpoints. A total of 238 patients undergoing transfemoral TAVI will be included. The primary endpoint is the incidence of clinically relevant bleeding (i.e. Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding) of the randomised secondary access site (either diagnostic or pacemaker access, or both) within 30 days after TAVI. Secondary endpoints include time to mobilisation after TAVI, duration of hospitalisation, any BARC type 2, 3 or 5 bleeding, and early safety at 30 days according to Valve Academic Research Consortium‑3 criteria. CONCLUSION The TAVI XS trial is the first randomised trial comparing an upper extremity approach to a lower extremity approach with regard to clinically relevant secondary access site-related bleeding complications. The results of this trial will provide important insights into the safety and efficacy of an upper extremity approach in patients undergoing transfemoral TAVI.
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Affiliation(s)
- Maxim J P Rooijakkers
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Geert A A Versteeg
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kimberley I Hemelrijk
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Hugo M Aarts
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Daniël C Overduin
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Dirk-Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Pieter J Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Marleen H van Wely
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lokien X van Nunen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Robert Jan van Geuns
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Leen A F M van Garsse
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Guillaume S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michel W A Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura Rodwell
- Department of Health Sciences, Section Biostatistics, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Khalefa BB, Ayyad M, Albandak M, Ayyad A, Yassin MNA, Awad AK. Left versus right ventricular pacing during TAVR and balloon aortic valvuloplasty: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2024. [PMID: 38946136 DOI: 10.1111/pace.15032] [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: 02/06/2024] [Revised: 04/08/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION While right ventricular pacing (RVP) is the conventional temporary pacing modality used for transcatheter aortic valve replacement (TAVR), this approach possesses inherent risks and procedural challenges. We aim to assess and compare the safety and efficacy of left ventricular pacing (LVP) and RVP during TAVR and balloon aortic valvuloplasty (BAV). METHODS Following PRISMA guidelines, a comprehensive literature search was conducted in four databases from inception to December 15th, 2023. We included observational studies and clinical trials comparing LVP with RVP during TAVR and BAV procedures. Primary outcomes included short-term mortality, mortality due to cardiac tamponade, and procedural complications including bleeding, vascular complications, and cardiac tamponade. Secondary outcomes comprised procedure duration and length of hospital stay. RESULTS Five studies involving 830 patients with RVP and 1577 with LVP were included. Short-term mortality was significantly higher in the RVP group (RR 2.32, 95% CI: [1.37-3.93], P = .002), as was the incidence of cardiac tamponade (RR 2.19, 95% CI: [1.11-4.32], P = .02). LVP demonstrated shorter hospital stays (MD = 1.34 d, 95% CI: [0.90, 1.78], P < .001) and reduced procedure duration (MD = 7.75 min, 95% CI: [5.08, 10.41], P < .00001) compared to RVP. New pacemaker implantation was higher in the RVP group (RR 2.23, 95% CI: [1.14, 4.39], P = .02). CONCLUSION LVP during TAVR and BAV emerges a safer alternative to RVP, offering reduced mortality, hospital stays, and procedure durations.
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Affiliation(s)
| | - Mohammed Ayyad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Maram Albandak
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Alaa Ayyad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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3
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Regueiro A, Alperi A, Vilalta V, Asmarats L, Baz JA, Nombela-Franco L, Calabuig A, Muñoz-García A, Sabaté M, Moris C, Picard-Deland M, Pelletier-Beaumont E, Rodés-Cabau J. Safety and Efficacy of TAVR With a Pressure Sensor and Pacing Guidewire: SAFE-TAVI Trial. JACC Cardiovasc Interv 2023; 16:3016-3023. [PMID: 37902144 DOI: 10.1016/j.jcin.2023.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The SavvyWire (OpSens Inc) is a 0.035-inch preshaped guidewire with dedicated pacing properties and a distal pressure sensor allowing for continuous hemodynamic pressure monitoring. OBJECTIVES This study sought to determine the efficacy and safety of the guidewire during transcatheter aortic valve replacement (TAVR) procedures. METHODS This prospective, multicenter clinical study included patients with severe aortic stenosis undergoing TAVR in 8 European centers. The primary efficacy endpoint was defined as effective left ventricular rapid pacing runs with the guidewire translating into a significant systemic pressure drop (below 60 mm Hg). The safety outcome included the absence of major procedural complications related to the guidewire. RESULTS A total of 121 patients (mean age: 82.2 ± 5.9 years, 50% women) were included in the study, and 119 (98.3%) patients were finally treated with the study device. A balloon-expandable valve was implanted in 45 (37.8%) patients. Predilatation and postdilatation were performed in 89 (74.8%) and 14 (11.8%) patients, respectively. The primary efficacy endpoint was achieved in 116 (98.3%) patients, and the mean aortic systolic arterial pressure achieved during rapid pacing was 46.6 ± 11.3 mm Hg. Hemodynamic assessment with the use of the OptoMonitor 3 (OpSens Inc) without additional catheter exchange was achieved in 117 (99.2%) patients. The safety endpoint was achieved in 117 (99.2%) patients. No procedural mortality, stroke, or ventricular perforation was reported. CONCLUSIONS The use of the guidewire during TAVR procedures appeared to be efficacious and safe. This device could help minimize interventions during the procedure and improve the clinical decision making after transcatheter heart valve deployment. (SavvyWire Efficacy and Safety in Transcatheter Aortic Valve Implantation Procedures [SAFE-TAVI]; NCT05492383).
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Affiliation(s)
- Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain.
| | - Alberto Alperi
- Instituto de Investigación Sanitaria del Principado de Asturias, Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Victoria Vilalta
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Luis Asmarats
- Cardiology Unit, Interventional Cardiology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Jose Antonio Baz
- Interventional Cardiology Unit, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - Alvaro Calabuig
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Antonio Muñoz-García
- Hospital Regional Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Málaga, Spain
| | - Manel Sabaté
- Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Cesar Moris
- Instituto de Investigación Sanitaria del Principado de Asturias, Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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Blusztein D, Raney A, Walsh J, Nazif T, Woods C, Daniels D. Best Practices in Left Ventricular Pacing for Transcatheter Aortic Valve Replacement. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100213. [PMID: 38046859 PMCID: PMC10692352 DOI: 10.1016/j.shj.2023.100213] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 12/05/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is continually evolving, with a recent emphasis on a "minimalist" approach toward reducing procedural invasiveness, duration, and recovery time. Whereas a better understanding of the relationship between TAVR and new conduction disturbances has led to improved periprocedural management, intraprocedural rapid-pacing techniques have not evolved beyond traditional right ventricular temporary pacing. An alternative strategy utilizing the left ventricular guidewire for rapid pacing has been developed with evidence supporting its safety, effectiveness, and potential reductions in procedure time and cost. This review will outline the current best practices in left ventricular pacing for TAVR, a practical technique that embraces the minimalist approach to TAVR and may be considered for routine use. It aims to explore the current evidence and combine this with expert opinion to offer a strategy for temporary pacing that encourages efficiencies for physicians and patients without compromising periprocedural safety.
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Affiliation(s)
- David Blusztein
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Aidan Raney
- Division of Cardiology, St. Joseph Hospital, Orange, California, USA
| | - Joe Walsh
- Division of Cardiology, St. Alphonsus Health System, Boise, Idaho, USA
| | - Tamim Nazif
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher Woods
- Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
| | - David Daniels
- Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
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Faurie B, Acheampong A, Abdellaoui M, Dessus I, Monsegu J, Wintzer-Wehekind J. Direct wire pacing during measurement of fractional flow reserve: A randomized proof-of-concept noninferiority crossover trial. Front Cardiovasc Med 2023; 10:1137309. [PMID: 37937287 PMCID: PMC10625906 DOI: 10.3389/fcvm.2023.1137309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/30/2023] [Indexed: 11/09/2023] Open
Abstract
Background Adenosine administration for fractional flow reserve (FFR) measurement may induce heart pauses. Aims To assess the accuracy and tolerability of direct wire pacing (DWP) during measurement of FFR. Methods Adults with at least one intermediate coronary artery stenosis (40%-80%) were consecutively enrolled between June 2021 and February 2022 in this randomized, noninferiority, crossover trial (NCT04970082) carried out in France. DWP was applied (DWP) or not (standard method) through the pressure guidewire used for FFR measurement during adenosine-induced maximal hyperaemia. Subjects were randomly assigned to the allocation sequence (DWP first or standard first). A 2-minute washout period was observed between the two FFR measurements performed for each stenosis. The primary endpoint was the reproducibility of FFR measurements between methods. Results A total of 150 focal lesions, presented by 94 subjects, were randomized (ratio: 1:1). The FFR values obtained with each method were nearly identical (R = 0.98, p = 0.005). The mean FFR difference of 0.00054 (95% confidence interval: 0.004 to 0.003) showed the noninferiority of FFR measurement with DWP vs. that with the standard method. Higher levels of chest discomfort were reported with DWP than with the standard method (0.61 ± 0.84 vs. 1.05 ± 0.89, p < 0.001), and a correlation was observed between the electrical sensations reported with DWP and chest discomfort (p < 0.001). Pauses (n = 20/148 lesions) were observed with the standard method, but did not correlate with chest discomfort (p = 0.21). No pauses were observed with DWP. Conclusions DWP during FFR measurement resulted in accurate and reproducible FFR values, and eliminated the pauses induced by adenosine.
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Affiliation(s)
| | - Angela Acheampong
- Institut Cardiovasculaire de Grenoble, Grenoble, France
- Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Ilona Dessus
- Institut Cardiovasculaire de Grenoble, Grenoble, France
- Université Grenoble-Alpes, CHU Grenoble-Alpes, Grenoble, France
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6
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Feldt K, Dalén M, Meduri CU, Kastengren M, Bager J, Hörnsten J, Omar A, Rück A, Saleh N, Linder R, Settergren M. Reducing cardiac tamponade caused by temporary pacemaker perforation in transcatheter aortic valve replacement. Int J Cardiol 2023; 377:26-32. [PMID: 36640966 DOI: 10.1016/j.ijcard.2023.01.015] [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: 10/09/2022] [Revised: 12/15/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cardiac tamponade caused by temporary right ventricular (RV) pacemaker perforation is a rare but serious complication in transcatheter aortic valve replacement (TAVR). AIMS To study the incidence of temporary pacemaker related cardiac tamponade in TAVR, and the relation to the type of pacemaker lead used in periprocedural temporary transvenous pacing. METHODS A single center registry of transfemoral TAVRs in 2014-2020. Main inclusion criterion was peri-operative use of a temporary RV pacing lead. Main exclusion criteria were a preoperatively implanted permanent pacemaker or the exclusive use of left ventricular guidewire pacing. Incident cardiac tamponade was classified as pacemaker lead related, or other. Patients were grouped according to type of temporary RV pacing wire. RESULTS 810 patients were included (age 80.5 ± 7.3 [mean ± standard deviation], female 319, 39.4%). Of these, 566 (69.9%) received a standard RV temporary pacing wire (RV-TPW), and 244 (30.1%) received temporary RV pacing through a permanent, passive pacemaker lead (RV-TPPL). In total, 18 (2.2%) events of cardiac tamponade occurred, 12 (67%) were pacemaker lead related. All pacemaker lead-related cardiac tamponades occurred in the group who received a standard RV-TPW and none in the group who received RV-TPPL (n = 12 [2.1%] vs. n = 0 [0%], p = 0.022). No difference in cardiac tamponade due to other causes was seen between the groups (p = 0.82). CONCLUSIONS The use of soft-tip RV-TPPL was associated with a lower risk of pacemaker related cardiac tamponade in TAVR. When perioperative pacing is indicated, temporary RV-TPPL may contribute to a significant reduction of cardiac tamponade in TAVR.
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Affiliation(s)
- Kari Feldt
- Department of Medicine, Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
| | - Magnus Dalén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Christopher U Meduri
- Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Mikael Kastengren
- Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Jessica Bager
- Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Jonas Hörnsten
- Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Aninda Omar
- Department of Cardiothoracic Surgery, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Andreas Rück
- Department of Medicine, Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Nawzad Saleh
- Department of Medicine, Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Rickard Linder
- Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Magnus Settergren
- Department of Medicine, Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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Fraccaro C, Tarantini G. Right ventricular pacing during TAVR: Make the things as simple as possible but not simpler. Int J Cardiol 2023; 377:42-43. [PMID: 36682690 DOI: 10.1016/j.ijcard.2023.01.022] [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: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy.
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
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Wintzer-Wehekind J, Lefèvre T, Benamer H, Monsegu J, Tchétché D, Garot P, Honton B, Dumonteil N, Abdellaoui M. A direct wire pacing device for transcatheter heart valve and coronary interventions: a first-in-human, multicentre study of the Electroducer Sleeve. EUROINTERVENTION 2023; 18:1150-1555. [PMID: 36484703 PMCID: PMC9976696 DOI: 10.4244/eij-d-22-00662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/07/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) and complex percutaneous coronary interventions (PCI) may require cardiac pacing during device delivery, generally requiring the insertion of a temporary pacing lead via an additional venous access site. The purpose-built Electroducer Sleeve device provides direct wire pacing without the need for a temporary venous pacemaker. AIMS This study assessed the safety of temporary cardiac pacing using the novel sleeve device during PCI. METHODS This was a multicentre, non-randomised, prospective, first-in-human, single-arm, pilot study. The primary endpoint was analysis of a safety outcome, defined as the occurrence of haematomas or bleeding complications at the device vascular access site. Secondary endpoints included analyses of effectiveness and qualitative outcomes. RESULTS Sixty patients (mean age: 77.9±9.6 years) from 4 centres in France were included: 39 (65%) underwent TAVI, and 21 (35%) underwent PCI. Procedures were performed using the sleeve with access through the radial (32 patients; 53.3%) or femoral arteries (26; 43.3%), or the femoral vein (2; 3.3%). Primary endpoint analysis revealed that 2 patients (3.3%) developed EArly Discharge After Transradial Stenting of CoronarY Arteries Study (EASY) grade I/Bleeding Academic Research Consortium (BARC) type I haematomas at the device access site. As a measure of effectiveness, a haemodynamic effect was observed after each spike delivery in 54 patients (90%). Analyses of other secondary endpoints showed that 2 patients (6.3%) presented asymptomatic radial artery occlusion. No allergies were reported. CONCLUSIONS This first-in-human trial using the Electroducer Sleeve indicated that this novel, purpose-built, temporary pacing device was safe and effective. Larger prospective studies are required to confirm these findings.
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Affiliation(s)
- Jérôme Wintzer-Wehekind
- Institut Cardiovasculaire de Grenoble, Grenoble, France
- Médipôle Lyon-Villeurbanne, Villeurbanne, France
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Hakim Benamer
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Jacques Monsegu
- Institut Cardiovasculaire de Grenoble, Grenoble, France
- Médipôle Lyon-Villeurbanne, Villeurbanne, France
| | - Didier Tchétché
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Benjamin Honton
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Nicolas Dumonteil
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Mohamed Abdellaoui
- Institut Cardiovasculaire de Grenoble, Grenoble, France
- Médipôle Lyon-Villeurbanne, Villeurbanne, France
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Tagliari AP, Taramasso M. New Practices in Transcatheter Aortic Valve Implantation: How I Do It in 2023. J Clin Med 2023; 12:jcm12041342. [PMID: 36835878 PMCID: PMC9964275 DOI: 10.3390/jcm12041342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) went through a huge evolution in the last decades. Previously performed under general anesthesia, with transoperative transesophageal echocardiography guidance and using cutdown femoral artery access, the procedure has now evolved into a minimalist approach, with local anesthesia, conscious sedation, and the avoidance of invasive lines becoming the new standards. Here, we discuss the minimalist TAVI approach and how we incorporate it into our current clinical practice.
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Affiliation(s)
- Ana Paula Tagliari
- Cardiovascular Surgery Department, Hospital São Lucas da PUC-RS, Porto Alegre 90619-900, Brazil
- Cardiovascular Surgery Department, Hospital Mãe de Deus, Porto Alegre 90880-0481, Brazil
- Correspondence: ; Tel.: +55-(51)-33205186
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich, Clinic of Cardiac Surgery, 8008 Zurich, Switzerland
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Masiero G, Paradies V, Franzone A, Bellini B, De Biase C, Karam N, Sanguineti F, Mamas MA, Eltchaninoff H, Fraccaro C, Castiglioni B, Attisano T, Esposito G, Chieffo A. Sex-Specific Considerations in Degenerative Aortic Stenosis for Female-Tailored Transfemoral Aortic Valve Implantation Management. J Am Heart Assoc 2022; 11:e025944. [PMID: 36172929 DOI: 10.1161/jaha.121.025944] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The impact of sex on pathophysiological processes, clinical presentation, treatment options, as well as outcomes of degenerative aortic stenosis remain poorly understood. Female patients are well represented in transfemoral aortic valve implantation (TAVI) trials and appear to derive favorable outcomes with TAVI. However, higher incidences of major bleeding, vascular complications, and stroke have been reported in women following TAVI. The anatomical characteristics and pathophysiological features of aortic stenosis in women might guide a tailored planning of the percutaneous approach. We highlight whether a sex-based TAVI management strategy might impact on clinical outcomes. This review aimed to evaluate the impact of sex from diagnosis to treatment of degenerative aortic stenosis, discussing the latest evidence on epidemiology, pathophysiology, clinical presentation, therapeutic options, and outcomes. Furthermore, we focused on technical sex-oriented considerations in TAVI including the preprocedural screening, device selection, implantation strategy, and postprocedural management.
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Affiliation(s)
- Giulia Masiero
- Department of Cardiac, Thoracic Vascular Science and Public Health, University of Padova Italy
| | - Valeria Paradies
- Department of Cardiology Maasstad Hospital Rotterdam The Netherlands
| | - Anna Franzone
- Department of Advanced Biomedical Sciences Federico II University of Naples Italy
| | - Barbara Bellini
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel Clinique Pasteur Toulouse France
| | - Nicole Karam
- Cardiology Department European Hospital Georges Pompidou Paris France
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group School of Medicine, Keele University Stoke-on-Trent United Kingdom.,Department of Cardiology Royal Stoke University Hospital Stoke-on-Trent United Kingdom.,Department of Medicine Thomas Jefferson University Philadelphia PA
| | | | - Chiara Fraccaro
- Department of Cardiac, Thoracic Vascular Science and Public Health, University of Padova Italy
| | | | - Tiziana Attisano
- Division of Interventional Cardiology Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi Salerno Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences Federico II University of Naples Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
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Rodés-Cabau J, Ibrahim R, De Larochellière R, Ben Ali W, Paradis JM, Robichaud S, Dorval JF, Mohammadi S, Dumont E, Kalavrouziotis D, Mesnier J, Panagides V, Picard-Deland M, Lalancette S, Pelletier-Beaumont E. A pressure wire for rapid pacing, valve implantation and continuous haemodynamic monitoring during transcatheter aortic valve implantation procedures. EUROINTERVENTION 2022; 18:e345-e348. [PMID: 35588013 PMCID: PMC9980398 DOI: 10.4244/eij-d-22-00190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec City, QC G1V 4G5, Canada
| | | | | | | | | | | | | | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | | | - Jules Mesnier
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
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12
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Savvoulidis P, Mechery A, Lawton E, Ludman PF, Sharma H, Thompson S, Khalil A, Kalogeropoulos A, Khan S, Nadir AM, Doshi SN. Comparison of left ventricular with right ventricular rapid pacing on tamponade during TAVI. Int J Cardiol 2022; 360:46-52. [PMID: 35597495 DOI: 10.1016/j.ijcard.2022.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Small studies have suggested left ventricular (LV) rapid pacing has similar safety and efficacy to conventional right ventricular (RV) rapid pacing in transcatheter aortic valve implantation (TAVI). However, there are limited data on the comparative rates of tamponade. The study compared the rate of cardiac tamponade between LV and RV-pacing during TAVI. METHODS Between 2008 and 2021, 1226 consecutive patients undergoing transfemoral or transaxillary TAVI were included. 470(38.3%) patients had TAVI deployment with RV-pacing and 756(61.7%) with LV-pacing. The primary outcome was the frequency and cause of cardiac tamponade. Secondary outcomes included efficacy, procedure duration and crossover rates. RESULTS There was a trend to less tamponade with LV-pacing, which did not reach statistical significance [11(2.3%) vs 11(1.5%);P = 0.27]. There was no significant difference in the frequency of tamponade due to annular tear [4(0.9%) vs 9(1.2%);P = 0.59] or LV free-wall perforation [1(0.2%) vs 2(0.3%);P = 0.86]. The frequency of tamponade due to RV perforation was significantly lower in the LV-pacing group [0 vs 6(2.3%);P < 0.005)]. Two patients with tamponade due to RV perforation required emergency sternotomy of whom one died. Deployment success was similar (99% vs 99.6%;P=NS). Procedure duration was shorter with LV-pacing (70 vs 80 mins;P < 0.005). Crossover to RV-pacing was low (0.9%). There were no embolizations caused by loss-of-capture in either group. CONCLUSIONS LV-pacing appears equally efficacious and is associated with a lower risk of tamponade due to RV perforation caused by the temporary pacing wire. LV-pacing was not associated with an increased risk of tamponade due to LV free-wall perforation.
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Affiliation(s)
- Panagiotis Savvoulidis
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Anthony Mechery
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Ewa Lawton
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Harish Sharma
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sophie Thompson
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Arsalan Khalil
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | | | - Sohail Khan
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Adnan M Nadir
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK..
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13
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Carey J, Buckley A, O'Connor S, Hensey M. The Wattson temporary pacing guidewire for transcatheter heart valve implantation. Future Cardiol 2021; 18:275-283. [PMID: 34875868 DOI: 10.2217/fca-2021-0105] [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: 11/21/2022] Open
Abstract
Transcatheter aortic valve implantation and implantation of other transcatheter heart valves, generally requires insertion of a temporary venous pacemaker. Implantation of a temporary venous pacemaker adds complexity, time and risk to the procedure. Guidewire modification to allow pacing is increasingly popular, however it requires technical expertise and provides unipolar pacing resulting in high thresholds and potential capture loss. The Wattson temporary pacing guidewire is a novel device which offers guidewire support for valve delivery and concomitant bipolar pacing. It may offer a safe and effective solution to guidewire pacing for transcatheter aortic valve implantation and other transcatheter heart valve implantations. Herein, we review the literature surrounding left ventricular guidewire pacing along with the features and clinical data of the Wattson wire.
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Affiliation(s)
- James Carey
- St James's Hospital, James St, Dublin 8, Ireland
| | | | | | - Mark Hensey
- St James's Hospital, James St, Dublin 8, Ireland
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14
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Hokken TW, de Ronde M, Wolff Q, Schermers T, Ooms JF, van Wiechen MP, Kardys I, Daemen J, de Jaegere PP, Van Mieghem NM. Insights in a restricted temporary pacemaker strategy in a lean transcatheter aortic valve implantation program. Catheter Cardiovasc Interv 2021; 99:1197-1205. [PMID: 34837467 PMCID: PMC9539864 DOI: 10.1002/ccd.30026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To study the safety and feasibility of a restrictive temporary-RV-pacemaker use and to evaluate the need for temporary pacemaker insertion for failed left ventricular (LV) pacing ability (no ventricular capture) or occurrence of high-degree AV-blocks mandating continuous pacing. BACKGROUND Ventricular pacing remains an essential part of contemporary transcatheter aortic valve implantation (TAVI). A temporary-right-ventricle (RV)-pacemaker lead is the standard approach for transient pacing during TAVI but requires central venous access. METHODS An observational registry including 672 patients who underwent TAVI between June 2018 and December 2020. Patients received pacing on the wire when necessary, unless there was a high-anticipated risk for conduction disturbances post-TAVI, based on the baseline-ECG. The follow-up period was 30 days. RESULTS A temporary-RV-pacemaker lead (RVP-cohort) was inserted in 45 patients, pacing on the wire (LVP-cohort) in 488 patients, and no pacing (NoP-cohort) in 139 patients. A bailout temporary pacemaker was implanted in 14 patients (10.1%) in the NoP-cohort and in 24 patients (4.9%) in the LVP-cohort. One patient in the LVP-cohort needed an RV-pacemaker for incomplete ventricular capture. Procedure time was significantly longer in the RVP-cohort (68 min [IQR 52-88.] vs. 55 min [IQR 44-72] in NoP-cohort and 55 min [IQR 43-71] in the LVP-cohort [p < 0.005]). Procedural high-degree AV-block occurred most often in the RVP-cohort (45% vs. 14% in the LVP and 16% in the NoP-cohort [p ≤ 0.001]). Need for new PPI occurred in 47% in the RVP-cohort, versus 20% in the NoP-cohort and 11% in the LVP-cohort (p ≤ 0.001). CONCLUSION A restricted RV-pacemaker strategy is safe and shortens procedure time. The majority of TAVI-procedures do not require a temporary-RV-pacemaker.
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Affiliation(s)
- Thijmen W Hokken
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marjo de Ronde
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Quinten Wolff
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Thom Schermers
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maarten P van Wiechen
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter P de Jaegere
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
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15
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Bricker RS, Cleveland JC, Messenger JC. Mechanical Complications of Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:465-480. [PMID: 34593110 DOI: 10.1016/j.iccl.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mechanical complications after transcatheter aortic valve replacement are fortunately rare with the current generation of devices. Unfortunately, life-threatening complications will occur and it is the responsibility of operators to be familiar with strategies to prevent and manage these challenging scenarios. Because these cases will not occur often, it is important for us to highlight and talk about those that do occur, to learn best practices in how to manage and prevent them going forward. We can learn much from each other's good crash landings.
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Affiliation(s)
- Rory S Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, USA
| | - Joseph C Cleveland
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, 6111, Aurora, CO 80045, USA
| | - John C Messenger
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, USA.
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16
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Tamura Y, Tamura Y, Konami Y, Suzuyama H, Horio E, Yamada M, Sassa T, Taguchi E, Horibata Y, Ideta I, Kawamura A, Sakamoto T. Comparison of left ventricular pacing performance among pre-shaped guidewires designed for transfemoral-approach transcatheter aortic valve implantation. Heart Vessels 2021; 37:460-466. [PMID: 34524498 DOI: 10.1007/s00380-021-01938-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
TAVI is an established therapy for patients with severe aortic stenosis. Rapid or control pacing is necessary for TAVI, and most centers are familiar with right ventricular (RV) pacing. Although there are several reports on the efficacy and safety of LV pacing, they are still few. In addition, LV pacing has not been studied for different LV guidewires. Our aim is to study the effectiveness of left ventricular (LV) pacing and the thresholds of LV guidewires in patients who underwent transcatheter aortic valve implantation (TAVI). We retrospectively analyzed 252 consecutive patients who underwent trans-femoral TAVI (TF-TAVI) with LV pacing in our institute between December 2017 and November 2020. We excluded 48 patients from the total cohort due to TAVI with RV pacing, and the remaining 204 patients were analyzed (52 males, mean age 85 ± 5 years). Among them, 202 patients (99.0%) had successful LV pacing. In the two patients with failed LV pacing, SAFARI2™ Small was used. The CONFIDA™ group (n = 34) showed a significantly lower threshold than the SAFARI2™ group (n = 163) (median 3.0 vs. 5.0 V; P = 1.1 × 10-7). LV pacing with Lunderquist® was successful in all patients (n = 7). LV pacing in TAVI was an effective and safe strategy. CONFIDA™ wire may be particularly well suited for LV pacing in TAVI.
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Affiliation(s)
- Yudai Tamura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan.,Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Yuichi Tamura
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Yutaka Konami
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Hiroto Suzuyama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Eiji Horio
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Masahiro Yamada
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Toshiharu Sassa
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Eiji Taguchi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Yoko Horibata
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Ichiro Ideta
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, 5-3-1 Chikami Minami-ku, Kumamoto, 861-4193, Japan.
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17
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Medina DE Chazal HA, Seropian IM, Romeo F, Chiabrando JG, Valle Raleigh J, Berrocal DH, Agatiello CR. Balloon aortic valvuloplasty through the novel transradial technique. Minerva Cardiol Angiol 2021; 69:458-463. [PMID: 33703866 DOI: 10.23736/s2724-5683.21.05611-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Balloon aortic valvuloplasty (BAV) has been typically performed through a femoral approach thus increasing the risk of bleeding and access site-related vascular complications. The aim of this study was to describe the safety and efficacy of transradial aortic valve valvuloplasty (TRBAV). METHODS The present research is a retrospective, single-center study including patients undergoing TRBAV (October 2019-July 2020). BAV was performed using 18-25 mm balloons through an 8-10 French (F) radial sheath. Successful BAV was defined as ≥50% reduction in peak-to-peak gradient (efficacy endpoint). Procedural complications, including radial artery occlusion (RAO) at follow-up were evaluated (safety endpoint). RESULTS Twenty-four patients underwent TRBAV were included, aged 81 (73-85) years, 70% males, EuroScoreII 3.1 (2.1-5.5). Aortic valve gradient was significantly reduced (pre-50±24 vs. 18.7±13 mmHg post, P<0.001), and 91% had successful BAV. Mean gradient drop was 31.4±16.8 mmHg. One patient (4%) required cross-over to femoral access for severe vasospasm and was excluded from the analysis. Most used sheaths were 8F (46%) and 9F (37%), mostly for 20 mm (50%) and 23 mm (38%) balloons. There were neither major procedural complications (neither balloon entrapment nor compartmental syndrome) nor minor complications (any access-site bleeding). RAO was observed in 2 patients (8%), both asymptomatic. CONCLUSIONS TRBAV was safe, feasible, and efficacious with a small rate of conversion and RAO, suggesting reproducibility of this novel technique. TRBAV may represent an alternative to femoral access in selected patients although larger studies are warranted.
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Affiliation(s)
| | - Ignacio M Seropian
- Department of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Romeo
- Icahn School of Medicine at Mount Sinai, Department of Medicine, Mount Sinai St. Luke's and West, New York, NY, USA
| | - Juan G Chiabrando
- Department of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Juan Valle Raleigh
- Department of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Daniel H Berrocal
- Department of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carla R Agatiello
- Department of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Lilly SM, Deshmukh AJ, Epstein AE, Ricciardi MJ, Shreenivas S, Velagapudi P, Wyman JF. 2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 76:2391-2411. [DOI: 10.1016/j.jacc.2020.08.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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19
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Ichibori Y, Puri R, Taramasso M, Nietlispach F, Attizzani GF, Meier B, Auffret V, Le Breton H, Cavalcante JL, Das R, Bhatt DL, Kapadia SR, Kalra A. An Optimized Approach for Transfemoral Transcatheter Aortic Valve Implantation: A Comprehensive Review and Current Evidence. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1034-1040. [DOI: 10.1016/j.carrev.2019.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/10/2019] [Accepted: 12/31/2019] [Indexed: 12/17/2022]
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20
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May A, Collins N, Jackson N, Fitzgerald J, Boyle A, Bhagwandeen R. Pacing Over the Guidewire in Cardiac Structural Intervention: A Practical Guide. Heart Lung Circ 2020; 29:e265-e268. [PMID: 32718903 DOI: 10.1016/j.hlc.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022]
Abstract
Left ventricular access for aortic valve intervention provides the opportunity to deliver rapid pacing over the guidewire for device positioning and deployment. Temporary pacing delivered via the left ventricle can obviate the need for venous access and has been shown to be a safe alternative to temporary right ventricular pacing. The technique requires some basic knowledge and experience in temporary cardiac pacing. We outline safe practical steps and common pitfalls in using this technique.
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Affiliation(s)
- Austin May
- John Hunter Hospital, Newcastle, NSW, Australia.
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21
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Van Wiechen MP, Ooms JF, Hokken TW, De Ronde-Tillmans MJ, Goudzwaard JA, Daemen J, De Jaegere PP, Mattace-Raso FU, Van Mieghem NM. Pathways Towards Lean TAVR. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2020.1765056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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22
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Kleczynski P, Dziewierz A, Socha S, Rakowski T, Daniec M, Zawislak B, Arif S, Wojtasik-Bakalarz J, Dudek D, Rzeszutko L. Direct Rapid Left Ventricular Wire Pacing during Balloon Aortic Valvuloplasty. J Clin Med 2020; 9:jcm9041017. [PMID: 32260289 PMCID: PMC7230545 DOI: 10.3390/jcm9041017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Rapid ventricular pacing is mandatory for optimal balloon positioning during aortic valvuloplasty (BAV) in patients with severe aortic stenosis. We aimed to assess the safety and efficacy of direct left ventricular (LV) guidewire pacing in comparison with regular pacing induced by temporary pacemaker (PM) placement in the right ventricle. Methods: Direct rapid LV pacing was provided with a 0.035″ guidewire. Baseline clinical characteristics, echocardiographic and procedural data, as well as complication rates, were compared between the two groups. Results: A total of 202 patients undergoing BAV were enrolled (49.5% with direct LV guidewire pacing). The pacing success rate was 100%. In the direct LV guidewire pacing group, we found a lower radiation dose, shorter fluoroscopy and overall procedural time (0.16 vs. 0.28 Gy, p = 0.02; 5.4 vs. 10.3 min, p = 0.01; 17 vs. 25 min, p = 0.01; respectively). In addition, the complication rate was lower in that group (cardiac tamponades, vascular access site complications, blood transfusions rate, and in-hospital mortality: 0% vs. 3.9%; 4.0% vs. 15.7%; 2.0% vs. 12.7%; 2.0% vs. 9.8%, p = 0.01 for all, respectively). Conclusions: Direct rapid LV guidewire pacing is a simple, safe and effective option for BAV with a reduced complication rate compared to a temporary PM placed in the right ventricle.
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Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
- Correspondence:
| | - Artur Dziewierz
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
| | - Sylwia Socha
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Tomasz Rakowski
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
| | - Marzena Daniec
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Barbara Zawislak
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
- Intensive Cardiac Care Unit, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland
| | - Saleh Arif
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Joanna Wojtasik-Bakalarz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
| | - Lukasz Rzeszutko
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
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Faurie B. Reply: Make it "EASY"! Yes, But How Much? JACC Cardiovasc Interv 2020; 13:786-787. [PMID: 32192700 DOI: 10.1016/j.jcin.2020.01.220] [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: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 10/24/2022]
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24
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Hensey M, Sathananthan J, Alkhodair A, Landes U, Wood DA, Daniels D, Webb JG. Single‐center prospective study examining use of the Wattson temporary pacing guidewire for transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:968-971. [DOI: 10.1002/ccd.28832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 02/25/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Mark Hensey
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
| | - Abdullah Alkhodair
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
| | - Uri Landes
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
| | - David A. Wood
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
| | - David Daniels
- Department of Interventional Cardiology Sutter Health San Francisco California USA
| | - John G. Webb
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
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Burzotta F, Aurigemma C, Romagnoli E, Shoeib O, Russo G, Zambrano A, Verdirosi D, Leone AM, Bruno P, Trani C. A less‐invasive totally‐endovascular (LITE) technique for trans‐femoral transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:459-470. [DOI: 10.1002/ccd.28697] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Enrico Romagnoli
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Osama Shoeib
- Cardiology Department Tanta University Tanta Egypt
| | - Giulio Russo
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Aniello Zambrano
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Diana Verdirosi
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Antonio Maria Leone
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Piergiorgio Bruno
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
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Rougé A, Abdellaoui M, Monségu J, Faurie B. Transcoronary Rapid Pacing Solving a Complex Retrograde Chronic Total Occlusion Procedure. JACC Case Rep 2019; 1:832-837. [PMID: 34316941 PMCID: PMC8289134 DOI: 10.1016/j.jaccas.2019.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 12/01/2022]
Abstract
We report a case of revascularization of the right coronary artery via the epicardial collateral, for which we used transcoronary rapid pacing to obtain cardiac standstill while puncturing the distal chronic total occlusion (CTO) cap. To our knowledge, this is the first case in which this technique has been used in CTO. (Level of Difficulty: Advanced.)
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27
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Left Ventricular Rapid Pacing Via the Valve Delivery Guidewire in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2449-2459. [DOI: 10.1016/j.jcin.2019.09.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 11/17/2022]
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28
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Kotronias RA, Scarsini R, De Maria GL, Rajasundaram S, Sayeed R, Krasopoulos G, Grebenik C, Keiralla A, Newton JD, Banning AP, Kharbanda RK. Ultrasound guided vascular access site management and left ventricular pacing are associated with improved outcomes in contemporary transcatheter aortic valve replacement: Insights from the OxTAVI registry. Catheter Cardiovasc Interv 2019; 96:432-439. [DOI: 10.1002/ccd.28578] [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: 04/15/2019] [Revised: 08/22/2019] [Accepted: 10/25/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Rafail A. Kotronias
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
- Department of Cardiovascular Medicine University of Oxford Oxford UK
| | - Roberto Scarsini
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
- Department of Medicine, Division of Cardiology University of Verona Verona Italy
| | | | | | - Rana Sayeed
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
| | | | | | - Amar Keiralla
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
| | - James D. Newton
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
| | - Adrian P. Banning
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
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29
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Villablanca PA, Frisoli T, O'Neill W, Eng M. Using the Arm for Structural Interventions: Case Selection or Wave of the Future. Interv Cardiol Clin 2019; 9:63-74. [PMID: 31733742 DOI: 10.1016/j.iccl.2019.08.007] [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: 10/25/2022]
Abstract
The transradial approach has emerged as the preferred alternative to the traditional transfemoral approach owing to the increased evidence of its safety and efficacy. The field of structural heart disease is rapidly evolving; however, periprocedural complications related to access site remain a major determinant of morbidity and mortality. The transradial approach as primary or secondary access site in structural heart interventions like transcatheter aortic valve replacement, balloon aortic valvuloplasty, alternative access, alcohol septal ablations, paravalvular leak, valve snaring, coronary protection, and ventricular septal defect is feasible, safe, with lower vascular complications and high procedural success.
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Affiliation(s)
- Pedro A Villablanca
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
| | - Tiberio Frisoli
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Marvin Eng
- Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
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30
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Wang CN, Malik PG, Payne DM, Saha T, Rosati F, AlHammad N, Baranchuk A. Rapid Ventricular Pacing Using Pre-Existing Cardiac Implantable Devices in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2230-2232. [PMID: 31699384 DOI: 10.1016/j.jcin.2019.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 11/28/2022]
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Akodad M, Lefèvre T, Lounes Y, Leclercq F. [TAVI simplification: A focus]. Ann Cardiol Angeiol (Paris) 2019; 68:418-422. [PMID: 31668597 DOI: 10.1016/j.ancard.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
After a first procedure carried out in 2002 by Pr Cribier's, Transcatheter Aortic Valve Replacement or TAVR revolutionized the management of aortic stenosis with a constant increase in the number of procedures performed worldwide. Experience of operators and teams and evolution of the technique has been accompanied by a drastic reduction in complications in patients at lower surgical risk. In parallel, the procedure was considerably simplified, carried out more and more under local anesthesia, with percutaneous femoral approach, secondary radial approach, prosthesis implantation without predilatation, rapid pacing on left ventricle wire and early discharge. Thus, the "simplified" TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety.
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Affiliation(s)
- M Akodad
- Service de cardiologie, centre hospitalier universitaire Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; PhyMed Exp, université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France.
| | - T Lefèvre
- Ramsay générale de santé, institut cardiovasculaire Paris Sud, 91300 Massy, France
| | - Y Lounes
- Service de chirurgie vasculaire, centre hospitalier universitaire Arnaud-de-Villeneuve, 34295 Montpellier, France
| | - F Leclercq
- Service de cardiologie, centre hospitalier universitaire Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; PhyMed Exp, université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France
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32
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Benamer H, Saighi Bouaouina M, Sanguineti F, Neylon A, Garot P, Hovasse T, Unterseeh T, Champagne S, Lefèvre T, Chevalier B. [TAVI in women, very encouraging results]. Ann Cardiol Angeiol (Paris) 2019; 68:429-433. [PMID: 31668338 DOI: 10.1016/j.ancard.2019.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
The population of elderly patients comprises a high percentage of women. This population is more vulnerable due to the presence of numerous comorbidities and is, therefore, particularly exposed to the risk of aortic valve degeneration, resulting in aortic valve stenosis whose symptoms are predictors of poor short-term outcomes. In the presence of symptomatic aortic stenosis, the recommended therapeutic option in this vulnerable population is the implementation of transcatheter aortic valve implantation, preferably via the femoral route. The outcomes of this procedure are better in women than in men despite a more frequent occurrence of vascular, bleeding and cerebral complications. Several hypotheses have been reported in the literature regarding the reasons for such differences. Among other reasons, it is likely that in female patients, the myocardium adjusts better to the occurrence of aortic stenosis and that recovery after valve treatment is also more optimal. Another explanation is the higher frequency of coronary artery disease in this older population. This has a considerable impact on the outcome even when coronary lesions are treated prior to valve implantation. There is still room for improvement and progress can be achieved by further reducing the size of the equipment used in order to decrease the diameter of the vascular access, and by continuing to simplify TAVI procedures. Less invasive techniques should result in decreased complication rates. In addition, dedicated studies should allow us to further improve our practice in this growing population of vulnerable patients.
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Affiliation(s)
- H Benamer
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; ICV-GVM La Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, Suresnes, France.
| | - M Saighi Bouaouina
- ICV-GVM La Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, Suresnes, France
| | - F Sanguineti
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - A Neylon
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - P Garot
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - T Hovasse
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - T Unterseeh
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - S Champagne
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - T Lefèvre
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - B Chevalier
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
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33
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Radial Artery Access for Percutaneous Cardiovascular Interventions: Contemporary Insights and Novel Approaches. J Clin Med 2019; 8:jcm8101727. [PMID: 31635342 PMCID: PMC6833028 DOI: 10.3390/jcm8101727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022] Open
Abstract
Since its introduction, the transradial access for percutaneous cardiovascular procedures has been associated with several advantages as compared to transfemoral approach, and has become the default for coronary angiography and intervention. In the last 30 years, a robust amount of evidence on the transradial approach has been mounted, promoting its diffusion worldwide. This article provides a comprehensive review of radial artery access for percutaneous cardiovascular interventions, including the evidence from clinical trials of transradial vs. transfemoral approach, technical considerations, access-site complications and limitations, alternative forearm accesses (e.g., ulnar and distal radial artery), and ultimately the use of the radial approach for structural interventions.
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34
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Ooms JF, van Wiechen M, Ziviello F, Kroon H, Ren B, Daemen J, De Jaegere P, Van Mieghem NM. Single-access balloon aortic valvuloplasty – an overview of contemporary technical improvements. EUROINTERVENTION 2019; 15:e766-e770. [DOI: 10.4244/eij-d-19-00074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Scarsini R, Kotronias RA, De Maria GL, Rajasundaram S, Cahill TJ, Brown R, Newton JD, Banning AP, Kharbanda RK. Routine Left Ventricular Pacing for Patients Undergoing Transcatheter Aortic Valve Replacement. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1649771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Roberto Scarsini
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Rafail A. Kotronias
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | | | | | - Thomas J. Cahill
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Robin Brown
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - James D. Newton
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Adrian P. Banning
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
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36
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Hensey M, Daniels D, Wood D, Webb JG. Early experience with a purpose-designed temporary pacing guidewire for transcatheter valve implantation. EUROINTERVENTION 2019; 15:e508-e509. [DOI: 10.4244/eij-d-19-00138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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Rodés-Cabau J, Ellenbogen KA, Krahn AD, Latib A, Mack M, Mittal S, Muntané-Carol G, Nazif TM, Sondergaard L, Urena M, Windecker S, Philippon F. Management of Conduction Disturbances Associated With Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 74:1086-1106. [DOI: 10.1016/j.jacc.2019.07.014] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022]
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38
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Moreno-Samos JC, Vidovich MI. Device Embolization in Transcatheter Aortic Valve Procedures: Expect the Unexpected. JACC Case Rep 2019; 1:105-107. [PMID: 34316760 PMCID: PMC8301513 DOI: 10.1016/j.jaccas.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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39
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Follansbee CW, Qureshi AM, Parekh DR, Howard TS, Kim JJ. Guidewire pacing during transcatheter aortic valve implantation in a patient with complex congenital heart disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1408-1410. [PMID: 31155732 DOI: 10.1111/pace.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/29/2022]
Abstract
We present a case of temporary guidewire pacing in a patient with Fontan anatomy during transcatheter aortic valve implantation. Temporary pacing was successfully achieved utilizing this method without complications. There is an increasing population of patients with complex congenital heart disease and expanding variety of transcatheter interventions. Due to limitations in vascular access and surgical anatomies, guidewire pacing may have a wide array of potential applications in pediatrics and the congenital heart disease population.
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Affiliation(s)
- Christopher W Follansbee
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Athar M Qureshi
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Dhaval R Parekh
- Department of Cardiology, Baylor College of Medicine, Houston, Texas.,Texas Heart Institute, Houston, Texas
| | - Taylor S Howard
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Jeffrey J Kim
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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40
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Kochergin NA, Shilov AA, Ovcharenko EA, Klyshnikov KI, Ganiukov VI. [Evolution of transcatheter aortic valve implantation: from planning to robotic systems]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:80-85. [PMID: 31149993 DOI: 10.33529/angio2019207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has evolved dramatically and is now standard of care for intermediate risk patients with aortic stenosis. The development of innovative transcatheter heart valves and refinement of technical skills have contributed to the decrease in complication rates associated with TAVI. Increased experience, smaller sheaths, rigorous pre-procedural planning and improved vascular closing techniques have resulted in markedly lower rates of vascular complications. The next step was the simplification of the procedure, which contributed to a further decrease in complications, reduced procedural time, and shorter hospital stay. Change-over from general anaesthesia to conscious sedation, refusal from predilatation, and use of the radial approach instead of the contralateral femoral approach are all instrumental in achieving optimal results. Prospects for development include visual assist systems and robotic systems that can potentially optimize the transcatheter aortic valve implantation process, improve safety and effectiveness of the procedure.
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Affiliation(s)
- N A Kochergin
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - A A Shilov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - E A Ovcharenko
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - K Iu Klyshnikov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - V I Ganiukov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
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41
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Coughlan JJ, Kiernan TJ, Arnous S. Alternative Access for Transcatheter Aortic Valve Implantation: Current Evidence and Future Directions. VASCULAR AND ENDOVASCULAR REVIEW 2019. [DOI: 10.15420/ver.2019.4.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is the usual technique for patients with severe aortic stenosis who are at high risk for surgical aortic valve replacement. The transfemoral (TF) route is the most commonly used access type, and significant progress in this procedure has greatly increased the proportion of patients who can undergo it. Not all patients are suitable for TF TAVI, however, so other routes, including transapical, transaortic, subclavian, trans-subclavian/transaxillary, transcarotid and transcaval, may need to be used. Evidence on these routes shows promising results but the majority of this is registry data rather than randomised controlled trials, so TF TAVI remains the safest access route and should be considered for most patients. However, in patients who are unsuitable for TF TAVI, alternative access routes are safe and feasible. The challenges concern choosing the best route, the valve to use and skill of the specialist centre. This article provides a overview of options for alternative vascular access in TAVI, the clinical rationale for using them, current evidence and areas for clinical investigation.
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Affiliation(s)
- JJ Coughlan
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland
| | - Thomas J Kiernan
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland
| | - Samer Arnous
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland
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42
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Capretti G, Urena M, Bouleti C, Himbert D. Transcatheter tricuspid valve-in-valve replacement: Making it simpler. Catheter Cardiovasc Interv 2019; 95:65-67. [PMID: 30811746 DOI: 10.1002/ccd.28170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 11/09/2022]
Abstract
Transcatheter tricuspid valve-in-valve replacement (TTVR) represents an attractive therapeutic option in very high surgical risk patients with degenerated tricuspid bioprostheses. However, the procedural management of these patients might be challenging due to their comorbidities, long lasting heart valve disease and the presence of left-sided mechanical prostheses. Thus, a more "minimally disruptive" procedure would have several potential benefits in such a frail population. We present the cases of four patients admitted for congestive heart failure due to severe degeneration of their tricuspid bioprostheses who were treated with a minimalist TTVR. The protocol combined continuation of the oral anticoagulant treatment with no bridging therapy, the use of a single venous access with local anesthesia, rapid pacing via the stiff right ventricular wire, and transthoracic echocardiographic guidance and assessment, with no need for contrast injection. Our protocol aims at simplifying the TTVR procedure and might be a useful tool to avoid procedural complications and reduce hospital stay.
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Affiliation(s)
- Giuliana Capretti
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, Paris, France
| | - Marina Urena
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, Paris, France
| | - Claire Bouleti
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, Paris, France
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43
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Overtchouk P, Collet JP. [Aortic stenosis in the elderly: The TAVI revolution]. Presse Med 2018; 48:165-172. [PMID: 30545690 DOI: 10.1016/j.lpm.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/28/2018] [Accepted: 11/07/2018] [Indexed: 11/15/2022] Open
Abstract
TAVI is currently recommended for severe symptomatic aortic stenosis in patients at prohibitive, high or intermediate surgical risk as estimated by surgical risk scores (STS score and EuroSCORE II). Comorbidity, technical feasibility of TAVI and concurrent pathology with need for complementary surgical correction are conditions to be considered to choose between open surgery and TAVI. The decision is often made by the "Heart Team". The transfemoral access must be favored. Conduction disturbance, stroke, bioprosthesis thrombosis and durability are the main setbacks of TAVI. Double antiplatelet therapy with aspirin and clopidogrel during 3 to 6 months is currently recommended after TAVI, followed by long-term aspirin single therapy.
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Affiliation(s)
- Pavel Overtchouk
- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Sorbonne Université, Université Paris 06 (UPMC), Inserm UMRS 1166, institut de cardiologie, Paris, France
| | - Jean-Philippe Collet
- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Sorbonne Université, Université Paris 06 (UPMC), Inserm UMRS 1166, institut de cardiologie, Paris, France.
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44
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Chopra M, Luk NHV, De Backer O, Søndergaard L. Simplification and optimization of transcatheter aortic valve implantation - fast-track course without compromising safety and efficacy. BMC Cardiovasc Disord 2018; 18:231. [PMID: 30526521 PMCID: PMC6288866 DOI: 10.1186/s12872-018-0976-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/03/2018] [Indexed: 01/09/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become an established therapeutic option for patients with symptomatic, severe aortic valve stenosis. Ageing of the Western and Asian population and expansion of indications for TAVI will lead to a substantial increase in the number of TAVI procedures performed worldwide within the next decades. In line with the maturation of TAVI over the past few years, there has also been a significant simplification and optimisation of the TAVI procedure. A minimalist TAVI procedure and fast-track TAVI course have been shown to have distinct advantages over the more traditional TAVI approach. The aim of this manuscript is to discuss strategies of TAVI simplification and optimization, with special focus on fast-track TAVI, without compromising safety and efficacy.
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Affiliation(s)
- Manik Chopra
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Ngai H V Luk
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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45
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Benamer H, Auffret V, Cayla G, Chevalier B, Dupouy P, Eltchaninoff H, Gilard M, Guerin P, Iung B, Koning R, Monsegu J, Lantelme P, Le Breton H, Lefèvre T, Verhoye JP, Commeau P, Motreff P. Position paper of French Interventional Group (GACI) for TAVI in France in 2018. Ann Cardiol Angeiol (Paris) 2018; 67:455-465. [PMID: 30376969 DOI: 10.1016/j.ancard.2018.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aortic stenosis is a frequent disease in the elderly. Its prevalence is 0.4% with a sharp increase after the age of 65, and its outcome is very poor when the patient becomes symptomatic. The interventional procedure known as TAVI (trans-catheter aortic valve implantation), which was developed in France and carried out for the first time in Rouen by Prof. Alain Cribier and his team in 2002, has proven to be a valid alternative to surgical aortic valve replacement. At first, this technique was shown to be efficient in patients with contra-indications to surgical treatment or deemed to be at high surgical risk. Given the very promising outcomes achieved as a result of close heart team collaboration, appropriate patient selection, simplified procedures and reduced complication rates, transfemoral (TF) TAVI is now preferred in symptomatic intermediate risk patients>75 years old according to the latest ESC guidelines. In 2017, in France, TAVI is currently performed in 50 centers with on-site cardiac surgery. The 2016 TAVI outcomes recorded in the French national TAVI registry (France TAVI) are very encouraging and show that for 7133 patients treated (age 83.4±7 years, logistic Euroscore 14%), 87% of whom via the TF approach, cross-over to surgery was very low (0.5%) with a 3.0% in-hospital mortality rate. The substantial increase in TAVI indications and the improvement of its outcomes may in the near future call for a reconsideration of the number of high volume centers authorized to carry out this technique.
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Affiliation(s)
- H Benamer
- ICPS Jacques Cartier, Ramsay générale de santé, 6, avenue du Noyer Lambert, 91300 Massy, France.
| | - V Auffret
- Inserm U1099, service de cardiologie et maladies vasculaires, CIC-IT 804, laboratoire de traitement du signal et de l'image, université de Rennes 1, CHU Pontchaillou, 35000 Rennes, France
| | - G Cayla
- Service de cardiologie, université de Montpellier, CHU Nîmes, 34000 Nîmes, France
| | - B Chevalier
- ICPS Jacques Cartier, Ramsay générale de santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - P Dupouy
- Hôpital privé d'Anthony, 25, rue De La Providence, 92160 Antony, France
| | - H Eltchaninoff
- Inserm U1096, department of cardiology, FHU REMOD-VHF, Rouen university hospital, Normandie Univ, Unirouen, 76000 Rouen, France
| | - M Gilard
- CHU La Cavale Blanche, boulevard Tanguy Prigent, 29609 Brest, France
| | - P Guerin
- CHU hôpital G R Laennec, boulevard Jacques Monod, 44800 St Herblain, France
| | - B Iung
- Hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - R Koning
- Clinique Saint Hilaire, 2, place Saint Hilaire, 76000 Rouen, France
| | - J Monsegu
- Groupe hospitalier mutualiste de Grenoble, 8, rue du Dr Calmette, 38000 Grenoble cedex 1, France
| | - P Lantelme
- Hôpital Croix Rousse, 103, Gr De La Croix Rousse à Lyon, 34000 Lyon, France
| | - H Le Breton
- Inserm U1099, service de cardiologie et maladies vasculaires, CIC-IT 804, laboratoire de traitement du signal et de l'image, université de Rennes 1, CHU Pontchaillou, 35000 Rennes, France
| | - T Lefèvre
- ICPS Jacques Cartier, Ramsay générale de santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - J-P Verhoye
- Service de chirurgie cardiaque, université de Rennes, CHU Pontchaillou, 35000 Rennes, France
| | - P Commeau
- Polyclinique Les Fleurs Quartier Quiez, 83190 Ollioules, France
| | - P Motreff
- Department of cardiology, Gabriel Montpied hospital, Clermont-Ferrand university hospital, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
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Díaz de la Llera LS, Cubero Gómez JM, Casquero Domínguez S, Fernández Quero M, Villa Gil-Ortega M, Guisado Rasco A. Estimulación ventricular izquierda a través de la guía del implante percutáneo de válvula aórtica. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Akodad M, Lefèvre T. TAVI: Simplification Is the Ultimate Sophistication. Front Cardiovasc Med 2018; 5:96. [PMID: 30087900 PMCID: PMC6066956 DOI: 10.3389/fcvm.2018.00096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/29/2018] [Indexed: 12/19/2022] Open
Abstract
Since its introduction in 2002, TAVI has evolved dramatically and is now standard of care for intermediate risk patients when the femoral approach can be implemented safely. The development of innovative transcatheter heart valves (THVs) and refinement of technical skills have contributed to the decrease in complication rates associated with TAVI4. Increased experience, smaller sheaths, rigorous pre-procedural planning and improved vascular closing techniques have resulted in markedly lower rates of vascular complications. The next step is the simplification of the procedure, which should contribute to a further decrease in complications, and also reduce procedural time, hospital stay as well as staff workload and costs. Moving to conscious sedation, no predilatation, no temporary pace maker and use of the radial approach as the contralateral approach are all instrumental in achieving this ultimate refinement.
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Affiliation(s)
- Mariama Akodad
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.,Centre Hospitalier Universitaire Arnaud de Villeneuve, Montpellier, France
| | - Thierry Lefèvre
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
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Rials SJ, Pershing M, Collins C. Guidewire Method for Measuring Local Left Ventricular Electrical Activation Time During Cardiac Resynchronization Implantation. J Innov Card Rhythm Manag 2018; 9:2989-2995. [PMID: 32477783 PMCID: PMC7252739 DOI: 10.19102/icrm.2018.090102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/04/2017] [Indexed: 12/27/2022] Open
Abstract
The timing of local activation at left ventricular (LV) pacing leads is measured from the onset of the QRS complex to the peak of the LV electrogram (QLV). Pacing from the sites of late activation is associated with higher response rates to cardiac resynchronization therapy (CRT). Prior studies have measured QLV from permanent pacing leads, or have used electroanatomic mapping systems. The current study compares QLV measurements made with a guidewire to those collected from permanent LV pacing leads positioned at the same venous site without the use of electroanatomic mapping systems. In this study, 20 patients undergoing CRT implantation (14 males, mean QRS: 164.0 ms) had QLV measurements taken using a guidewire. QLV and LV electrogram duration measurements were made at LV pacing sites, and were repeated after positioning the permanent LV pacing lead at the same site. There was no difference in QLV measurements obtained using a guidewire and those obtained using the permanent pacing lead placed at the same site (p = 0.569). QLV measurements obtained with a guidewire and the permanent LV pacing lead at the same site, respectively, were strongly correlated (r = 0.965; p < 0.001). The median absolute difference in electrogram duration was 7.0 ms (p = 0.55). The average time required to make QLV measurements using the guidewire was 11.7 minutes [standard deviation (SD): 6.8]. The average total fluoroscopy time for the entire CRT implant procedure was 10.9 minutes (SD: 5.1). In light of these results, it can be suggested that a guidewire can be used to prospectively measure LV prior to selection or placement of a permanent pacing lead without the use of an electroanatomic mapping system.
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Affiliation(s)
- Seth J Rials
- OhioHealth Heart and Vascular Physicians, Division of Cardiology, Grant Medical Center, Columbus, OH, USA
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Díaz de la Llera LS, Cubero Gómez JM, Casquero Domínguez S, Fernández Quero M, Villa Gil-Ortega M, Guisado Rasco A. Guidewire-driven Left Ventricular Pacing During Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2017; 71:869-871. [PMID: 28941981 DOI: 10.1016/j.rec.2017.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - José María Cubero Gómez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Sara Casquero Domínguez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Mónica Fernández Quero
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Villa Gil-Ortega
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Agustín Guisado Rasco
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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50
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Steinvil A, Satler L. Does the removal of the temporary pacer wire for BAV and TAVR really simplify the procedure? Catheter Cardiovasc Interv 2017; 89:787-788. [PMID: 28342250 DOI: 10.1002/ccd.27013] [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: 02/06/2017] [Accepted: 02/15/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Arie Steinvil
- Interventional Cardiology, Medstar Washington hospital center, Washington, District of Columbia
| | - Lowell Satler
- Interventional Cardiology, Medstar Washington hospital center, Washington, District of Columbia
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