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Gennari M, Maccarana A, Severgnini G, Iennaco V, Bonomi A, Capra N, De Marco F, Muratori M, Fusini L, Polvani G, Agrifoglio M. See It Best: A Propensity-Matched Analysis of Ultrasound-Guided versus Blind Femoral Artery Puncture in Balloon-Expandable TAVI. J Clin Med 2024; 13:1514. [PMID: 38592382 PMCID: PMC10935327 DOI: 10.3390/jcm13051514] [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: 12/20/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Currently, transcatheter aortic valve implantation (TAVI) is the standard procedure recommended for patients over 75 years of age with symptomatic aortic valve stenosis. Percutaneous transfemoral (TF) access is the main route used to perform the procedure. Among periprocedural complications, access-related ones are the most frequent, potentially leading to prolonged in-hospital stays and transfusions. Methods: We performed a retrospective analysis of prospectively collected data on consecutive patients undergoing TF-TAVI with the latest generation balloon-expandable transcatheter valve between 2013 and 2022. Results: A total of 600 patients were analyzed, differentiating the population between ultrasound-guided and blind common femoral artery puncture. Valve Academic Research Consortium 3 (VARC-3)criteria were used to report at 30 days and follow-up. In our propensity-matched comparison of the two groups, we found a strong reduction in access-related complications in the echo-guided group, particularly in terms of reduction of major and minor bleedings. We also found a significant trend in reduction of local complications, such as pseudoaneurysms, hematomas, arterio-venous fistulas, dissection of the femoral or iliac arteries, and stenosis. Conclusions: Although there is a lack of consensus on the role of ultrasound-guided puncture, we found better outcomes for patients having an echo-guided puncture of the main access, particularly with regard to access-related complications, early mobilization, and early discharge home.
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Affiliation(s)
- Marco Gennari
- Centro Cardiologico Monzino IRCCS, Department of Invasive Cardiology, Structural and Valvular Interventional Cardiology Unit, 20138 Milan, Italy;
| | - Agnese Maccarana
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Surgery, 20138 Milan, Italy; (A.M.); (V.I.); (G.P.); (M.A.)
| | - Gaia Severgnini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Surgery, 20138 Milan, Italy; (A.M.); (V.I.); (G.P.); (M.A.)
| | - Vittoria Iennaco
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Surgery, 20138 Milan, Italy; (A.M.); (V.I.); (G.P.); (M.A.)
| | - Alice Bonomi
- Centro Cardiologico Monzino IRCCS, Department of Biostatistics, 20138 Milan, Italy; (A.B.); (N.C.)
| | - Nicolò Capra
- Centro Cardiologico Monzino IRCCS, Department of Biostatistics, 20138 Milan, Italy; (A.B.); (N.C.)
| | - Federico De Marco
- Centro Cardiologico Monzino IRCCS, Department of Invasive Cardiology, Structural and Valvular Interventional Cardiology Unit, 20138 Milan, Italy;
| | - Manuela Muratori
- Centro Cardiologico Monzino IRCCS, Department of Imaging, 20138 Milan, Italy; (M.M.); (L.F.)
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Department of Imaging, 20138 Milan, Italy; (M.M.); (L.F.)
| | - Gianluca Polvani
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Surgery, 20138 Milan, Italy; (A.M.); (V.I.); (G.P.); (M.A.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy
| | - Marco Agrifoglio
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Surgery, 20138 Milan, Italy; (A.M.); (V.I.); (G.P.); (M.A.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy
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Niebauer J, Bäck C, Bischoff-Ferrari HA, Dehbi HM, Szekely A, Völler H, Sündermann SH. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Prev Cardiol 2024; 31:146-181. [PMID: 37804173 DOI: 10.1093/eurjpc/zwad304] [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: 10/10/2022] [Revised: 03/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Josef Niebauer
- Paracelsus Medical University Salzburg, Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- REHA-Zentrum Salzburg, University Hospital Salzburg, Austria
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, RT, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hakim-Moulay Dehbi
- University College London, Comprehensive Clinical Trials Unit, London, Great Britain
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
| | - Heinz Völler
- Faculty of Health Sciences Brandenburg, University of Potsdam, Department of Rehabilitation Medicine, Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Simon H Sündermann
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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3
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Sündermann SH, Bäck C, Bischoff-Ferrari HA, Dehbi HM, Szekely A, Völler H, Niebauer J. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Cardiothorac Surg 2023; 64:ezad181. [PMID: 37804175 DOI: 10.1093/ejcts/ezad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Simon H Sündermann
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, RT, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hakim-Moulay Dehbi
- University College London, Comprehensive Clinical Trials Unit, London, Great Britain
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
| | - Heinz Völler
- Faculty of Health Sciences Brandenburg, University of Potsdam, Department of Rehabilitation Medicine, Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Josef Niebauer
- Paracelsus Medical University Salzburg, Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- REHA-Zentrum Salzburg, University Hospital Salzburg, Austria
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4
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Xenogiannis I, Varlamos C, Keeble TR, Kalogeropoulos AS, Karamasis GV. Ultrasound-Guided Femoral Vascular Access for Percutaneous Coronary and Structural Interventions. Diagnostics (Basel) 2023; 13:2028. [PMID: 37370923 DOI: 10.3390/diagnostics13122028] [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: 05/06/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Radial access has largely substituted femoral access for coronary interventions. Nevertheless, the femoral artery remains indispensable for gaining access to structural and complex percutaneous coronary interventions such as transcatheter aortic valve implantation and chronic total occlusion interventions, respectively. Ultrasound-guided femoral puncture is a broadly available, inexpensive, and relatively easy-to-learn technique. According to the existing evidence, ultrasound guidance for gaining femoral access has improved the effectiveness and safety of the technique. In the present paper, we sought to review the current literature in order to provide the reader with up-to-date data regarding the benefits of ultrasound-guided femoral access compared with the conventional technique as well as describing the state-of-the-art technique for gaining femoral access under ultrasound guidance.
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Affiliation(s)
- Iosif Xenogiannis
- Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
- Department of Cardiology, Mitera General Hospital, 151 23 Athens, Greece
| | - Charalampos Varlamos
- Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK
| | | | - Grigoris V Karamasis
- Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK
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5
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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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6
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Avvedimento M, Nuche J, Farjat-Pasos JI, Rodés-Cabau J. Bleeding Events After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:684-702. [PMID: 36792284 DOI: 10.1016/j.jacc.2022.11.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/21/2022] [Indexed: 02/15/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has gained over time a major reduction in procedural complications. Despite this, clinically relevant bleeding still occurs in a non-negligible proportion of patients and adversely affects prognosis. Patients with severe aortic stenosis are at heightened risk for spontaneous bleeding due to advanced age and a high comorbidity burden. Also, procedural factors and antithrombotic management contribute to define individual bleeding susceptibility. Bleeding prevention represents an emerging area for improving patient care. Because of the tight hemorrhagic/ischemic balance, a tailored approach based on individual bleeding-risk profile, such as a less invasive antithrombotic regimen or appropriate diagnostic preprocedural evaluation, should be pursued to avoid bleeding events. This review aims to provide an in-depth overview of bleeding events in the TAVR field, including definitions, timing and the extent of risk, and clinical impact, as well as updates on antithrombotic management and its potential influence on bleeding complications.
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Affiliation(s)
- Marisa Avvedimento
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jorge Nuche
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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7
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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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Vetrovec GW, Kaki A, Wollmuth J, Dahle TG. Strategies for Reducing Vascular and Bleeding Risk for Percutaneous Left Ventricular Assist Device-supported High-risk Percutaneous Coronary Intervention. Heart Int 2022; 16:105-111. [PMID: 36741103 PMCID: PMC9872781 DOI: 10.17925/hi.2022.16.2.105] [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: 11/24/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
In patients at high risk for haemodynamic instability during percutaneous coronary intervention (PCI), practitioners are increasingly opting for prophylactic mechanical circulatory support, such as the Impella® heart pump (Abiomed, Danvers, MA, USA). Though Impella-supported high-risk PCI (HRPCI) ensures haemodynamic stability during the PCI procedure, access-related complication rates have varied significantly in published studies. Reported variability in complication rates relates to many factors, including anticoagulation practices, access and closure strategy, post-procedure care and variations in event definitions. This article aims to outline optimal strategies to minimize vascular and bleeding complications during Impella-supported HRPCI based on previously identified clinical, procedural and postprocedural risk factors. Practices to reduce complications include femoral skills training, standardized protocols to optimize access, closure, anticoagulation management and post-procedural care, as well as the application of techniques and technological advances. Protocols integrating these strategies to mitigate access-related bleeding and vascular complications for Impella-supported procedures can markedly limit vascular access risk as a barrier to appropriate large-bore mechanical circulatory support use in HRPCI.
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Affiliation(s)
- George W Vetrovec
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amir Kaki
- Division of Cardiology, St. John’s Hospital, Wayne State University, Detroit, MI, USA
| | - Jason Wollmuth
- Providence Heart and Vascular Institute, Providence, OR, USA
| | - Thom G Dahle
- CentraCare Heart & Vascular Center, St. Cloud Hospital, St. Cloud, MN, USA
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10
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Artemiou P, Gasparovic I, Hudec V, Hulman M. The efficiency of the preoperative extracorporeal membrane oxygenation in the setting of postinfarction ventricular septal defect and how to optimize outcomes: A single center case series. J Card Surg 2022; 37:1416-1421. [PMID: 35182446 DOI: 10.1111/jocs.16333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/13/2022] [Accepted: 02/01/2022] [Indexed: 11/27/2022]
Abstract
The mortality rate after the development of postinfarction ventricular septal defect remains high despite progress in pharmacologic therapy, invasive cardiology, and surgical techniques. We present a case series of six patients with preoperative venoarterial extracorporeal membrane oxygenation as a bridge to reparative surgical repair. Venoarterial extracorporeal membrane oxygenation allows to hemodynamically stabilize the patient, and safely delay the surgery. Delayed surgery might facilitate successful repair by allowing friable tissue to organize, strengthen, and become well-differentiated from surrounding healthy tissue; thus, definite repair can be performed safely. All patients were in cardiogenic shock and would otherwise require emergent cardiac surgery with associated risk. Three patients were discharged, with one hospital mortality of a patient who had a successful bridge to corrective surgery and died due to pulmonary artery rupture after a right ventricular assist device implantation. Two patients died before surgery while they were supported by venoarterial extracorporeal membrane oxygenation due to vascular complications. We discuss strategies how to optimize the management and function of the venoarterial extracorporeal membrane oxygenation to decrease the rate of adverse effects and optimize the outcomes of these patients.
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Affiliation(s)
- Panagiotis Artemiou
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Ivo Gasparovic
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Vladan Hudec
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Michal Hulman
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, Bratislava, Slovakia
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11
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Marcusohn E, Qasum M, Epstein D, Solomonica A, Orbach A, Musallam A, Kerner A, Feld Y. Vascular Complications Among Patients Undergoing Trans-femoral Transcatheter Aortic Valve Implantation: Prostar vs ProGlide Parallel Technique. Angiology 2022; 73:635-642. [PMID: 35147041 DOI: 10.1177/00033197211058498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Reliable femoral artery closure devices are essential for the success of trans-femoral Transcatheter Aortic Valve Implantation (TAVI) procedures. Accordingly, device choice might affect vascular complications and bleeding rates. This was a retrospective analysis, comparing vascular complication rates among patients who underwent trans-femoral TAVI with vascular access closure using either the ProGlide parallel suture or Prostar closure devices. We included 191 patients: 106 were treated with Prostar and 85 with ProGlide. The ProGlide group had higher rate of diabetes, chronic kidney disease, peripheral arterial disease, and significantly smaller femoral arteries that were treated via larger sheaths. Valve Academic Research Consortium (VARC)-2 major complications were similar between the groups. (4.7% for ProGlide vs 3.8% for Prostar, P=1), with similar incidence of closure device failure (2 vs 3, P=1). No differences were found after univariant analysis and propensity-score matching in the incidence of major and minor bleeding nor in the rate of in-hospital mortality between ProGlide and Prostar (4.7 vs 2.8%, P=.7, 1.2 vs 2.8%, P=.63, and 1.2 vs .0%, P=.45, respectively). Parallel suture technique using two ProGlide sutures showed comparable rates of vascular complications to the Prostar closure device in higher risk population of TAVI patients.
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Affiliation(s)
- Erez Marcusohn
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Majd Qasum
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Amir Solomonica
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ady Orbach
- Schulich Heart Center - Sunnybrook Health Science Center, Toronto, ON, Canada
| | - Anees Musallam
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Arthur Kerner
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yair Feld
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Kotronias RA, Bray JJH, Rajasundaram S, Vincent F, Delhaye C, Scarsini R, Marin F, Terentes-Printzios D, Halcox JPJ, Mamas MA, Kharbanda R, Van Belle E, Banning AP. Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis. Circ Cardiovasc Interv 2021; 14:e010742. [PMID: 34538068 PMCID: PMC8522629 DOI: 10.1161/circinterventions.121.010742] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access. Methods: Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications. Results: Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35–0.73]), major (MH-OR, 0.51 [95% CI, 0.35–0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38–0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39–0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29–0.90]; MH-OR, 0.44 [95% CI, 0.20–0.99], respectively). Conclusions: In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020218259.
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Affiliation(s)
- Rafail A Kotronias
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, United Kingdom (R.A.K., J.J.H.B., S.R., R.S., F.M., D.T.-P., R.K., A.P.B.).,Department of Cardiovascular Medicine, University of Oxford, United Kingdom (R.A.K.)
| | - Jonathan J H Bray
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, United Kingdom (R.A.K., J.J.H.B., S.R., R.S., F.M., D.T.-P., R.K., A.P.B.).,Institute of Life Sciences 2, Swansea Bay University Health Board and Swansea University Medical School, United Kingdom (J.J.H.B., J.P.J.H.).,University Hospital of Wales, Cardiff and Vale University Health Board, United Kingdom (J.J.H.B.)
| | - Skanda Rajasundaram
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, United Kingdom (R.A.K., J.J.H.B., S.R., R.S., F.M., D.T.-P., R.K., A.P.B.)
| | - Flavien Vincent
- Centre Hospitalier Universitaire de Lille-Cardiologie, France (F.V., C.D., E.V.B.)
| | - Cedric Delhaye
- Centre Hospitalier Universitaire de Lille-Cardiologie, France (F.V., C.D., E.V.B.)
| | - Roberto Scarsini
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, United Kingdom (R.A.K., J.J.H.B., S.R., R.S., F.M., D.T.-P., R.K., A.P.B.).,Department of Medicine, Division of Cardiology, University of Verona, Italy (R.S.)
| | - Federico Marin
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, United Kingdom (R.A.K., J.J.H.B., S.R., R.S., F.M., D.T.-P., R.K., A.P.B.)
| | - Dimitrios Terentes-Printzios
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, United Kingdom (R.A.K., J.J.H.B., S.R., R.S., F.M., D.T.-P., R.K., A.P.B.)
| | - Julian P J Halcox
- Institute of Life Sciences 2, Swansea Bay University Health Board and Swansea University Medical School, United Kingdom (J.J.H.B., J.P.J.H.)
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK and Heart Centre, Thomas Jefferson University, Philadelphia (M.A.M.)
| | - Rajesh Kharbanda
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, United Kingdom (R.A.K., J.J.H.B., S.R., R.S., F.M., D.T.-P., R.K., A.P.B.)
| | - Eric Van Belle
- Centre Hospitalier Universitaire de Lille-Cardiologie, France (F.V., C.D., E.V.B.)
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, United Kingdom (R.A.K., J.J.H.B., S.R., R.S., F.M., D.T.-P., R.K., A.P.B.)
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13
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McInerney A, Tirado-Conte G, Rodes-Cabau J, Campelo-Parada F, Tafur Soto JD, Barbanti M, Muñoz-Garcia E, Arif M, Lopez D, Toggweiler S, Veiga G, Pylko A, Sevilla T, Compagnone M, Regueiro A, Serra V, Carnero M, Oteo JF, Rivero F, Barbosa Ribeiro H, Guimaraes L, Matta A, Giraldo Echavarria N, Valvo R, Moccetti F, Muñoz-Garcia AJ, Lopez-Pais J, Garcia Del Blanco B, Campanha Borges DC, Dumont E, Gonzalo N, Criscione E, Dabrowski M, Alfonso F, de la Torre Hernández JM, Cheema AN, Amat-Santos IJ, Saia F, Escaned J, Nombela-Franco L. Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e019051. [PMID: 34056919 PMCID: PMC8477858 DOI: 10.1161/jaha.120.019051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is a paucity of outcome data on patients who are morbidly obese (MO) undergoing transcatheter aortic valve replacement. We aimed to determine their periprocedural and midterm outcomes and investigate the impact of obesity phenotype. Methods and Results Consecutive patients who are MO (body mass index, ≥40 kg/m2, or ≥35 kg/m2 with obesity-related comorbidities; n=910) with severe aortic stenosis who underwent transcatheter aortic valve replacement in 18 tertiary hospitals were compared with a nonobese cohort (body mass index, 18.5-29.9 kg/m2, n=2264). Propensity-score matching resulted in 770 pairs. Pre-transcatheter aortic valve replacement computed tomography scans were centrally analyzed to assess adipose tissue distribution; epicardial, abdominal visceral and subcutaneous fat. Major vascular complications were more common (6.6% versus 4.3%; P=0.043) and device success was less frequent (84.4% versus 88.1%; P=0.038) in the MO group. Freedom from all-cause and cardiovascular mortality were similar at 2 years (79.4 versus 80.6%, P=0.731; and 88.7 versus 87.4%, P=0.699; MO and nonobese, respectively). Multivariable analysis identified baseline glomerular filtration rate and nontransfemoral access as independent predictors of 2-year mortality in the MO group. An adverse MO phenotype with an abdominal visceral adipose tissue:subcutaneous adipose tissue ratio ≥1 (VAT:SAT) was associated with increased 2-year all-cause (hazard ratio [HR], 3.06; 95% CI, 1.20-7.77; P=0.019) and cardiovascular (hazard ratio, 4.11; 95% CI, 1.06-15.90; P=0.041) mortality, and readmissions (HR, 1.81; 95% CI, 1.07-3.07; P=0.027). After multivariable analysis, a (VAT:SAT) ratio ≥1 remained a strong predictor of 2-year mortality (hazard ratio, 2.78; P=0.035). Conclusions Transcatheter aortic valve replacement in patients who are MO has similar short- and midterm outcomes to nonobese patients, despite higher major vascular complications and lower device success. An abdominal VAT:SAT ratio ≥1 identifies an obesity phenotype at higher risk of adverse clinical outcomes.
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Affiliation(s)
- Angela McInerney
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
| | - Gabriela Tirado-Conte
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
| | - Josep Rodes-Cabau
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | | | | | - Erika Muñoz-Garcia
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares Cardiology Department Hospital Universitario Virgen de la Victoria Málaga Spain
| | - Mobeena Arif
- Division of Cardiology St. Michael's HospitalToronto University Toronto Ontario Canada
| | - Diego Lopez
- Hospital Clínico Universitario de SantiagoCIBERCV Santiago Spain
| | | | - Gabriela Veiga
- Hospital Universitario Marques de Valdecilla IDIVAL Santander Spain
| | - Anna Pylko
- Department of Interventional Cardiology and Angiology National Institute of Cardiology Warsaw Poland
| | - Teresa Sevilla
- CIBERCVInstituto de Ciencias del CorazónHospital Clínico Universitario de Valladolid Valladolid Spain
| | - Miriam Compagnone
- Cardiology Unit Cardio-Thoracic-Vascular Department University Hospital of BolognaPoliclinico S, Orsola-Malpighi Bologna Italy
| | - Ander Regueiro
- Cardiology Department Cardiovascular Institute, Hospital ClínicUniversidad de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Viçent Serra
- Hospital General Universitari Vall d'Hebron Barcelona Spain
| | - Manuel Carnero
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
| | - Juan F Oteo
- Department of Cardiology Hospital Universitario Puerta de Hierro Majadahonda Spain
| | - Fernando Rivero
- Cardiology Department Hospital Universitario de la PrincesaInstituto de Investigación Sanitaria Princesa (IIS-IP)Universidad Autónoma de Madrid, CIBER-CV Madrid Spain
| | | | - Leonardo Guimaraes
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - Anthony Matta
- Cardiology Department Rangueil University Hospital Toulouse France
| | | | - Roberto Valvo
- Ferrarotto Hospital University of Catania Catania Italy
| | | | - Antonio J Muñoz-Garcia
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares Cardiology Department Hospital Universitario Virgen de la Victoria Málaga Spain
| | | | | | | | - Eric Dumont
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - Nieves Gonzalo
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
| | | | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology National Institute of Cardiology Warsaw Poland
| | - Fernando Alfonso
- Cardiology Department Hospital Universitario de la PrincesaInstituto de Investigación Sanitaria Princesa (IIS-IP)Universidad Autónoma de Madrid, CIBER-CV Madrid Spain
| | | | - Asim N Cheema
- Division of Cardiology St. Michael's HospitalToronto University Toronto Ontario Canada
| | - Ignacio J Amat-Santos
- CIBERCVInstituto de Ciencias del CorazónHospital Clínico Universitario de Valladolid Valladolid Spain
| | - Francesco Saia
- Cardiology Unit Cardio-Thoracic-Vascular Department University Hospital of BolognaPoliclinico S, Orsola-Malpighi Bologna Italy
| | - Javier Escaned
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
| | - Luis Nombela-Franco
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
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14
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Morozowich ST, Sell-Dottin KA, Crestanello JA, Ramakrishna H. Transcarotid Versus Transaxillary/Subclavian Transcatheter Aortic Valve Replacement (TAVR): Analysis of Outcomes. J Cardiothorac Vasc Anesth 2021; 36:1771-1776. [PMID: 34083097 DOI: 10.1053/j.jvca.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/11/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the percutaneous management of valvular heart disease and has evolved to progressively minimalist techniques over the past decade. This review discusses the impact of minimalist TAVR, explores the alternative approaches when transfemoral (TF) TAVR is not possible, and analyzes the current outcomes of transcarotid (TC) versus transaxillary/subclavian (TAx) TAVR, which are the two leading nonfemoral (NF) approaches emerging as the preferred alternatives to TF TAVR.
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Affiliation(s)
- Steven T Morozowich
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ
| | | | | | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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15
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Sinclair N, Mordhorst A, Yang GK, MacDonald PS, Sidhu R, Reid JDS. Vascular Access Complications and Clinical Outcomes of Vascular Surgical Repairs Following Transcatheter Aortic Valve Implantation (TAVI). Ann Vasc Surg 2021; 74:258-263. [PMID: 33549772 DOI: 10.1016/j.avsg.2020.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) procedures have revolutionized the treatment of aortic stenosis. However, due to large sheaths, improperly deployed closure devices, and the comorbidities and challenges innate to this population, vascular access complications can be devastating. The objective of this study is to evaluate vascular access complications in one of the largest TAVI sites in North America. METHODS This was a retrospective single center review between January 2014 and December 2018 of vascular access complications necessitating operative intervention by vascular surgery. Patient demographics and preoperative comorbidities were collected. Type of vascular access complication, types of repair, closure device used, and postoperative outcomes were analyzed. RESULTS A total of 37 cases out of a total of 985 TAVI procedures were identified. TAVI was carried out in the operating suite (70%) or the catheterization lab (30%). Consults to vascular surgery were requested intraoperatively (60%), immediately postoperative (14%), later in the day of the TAVI (20%), and on postoperative day 1 (6%). The location of injury included common femoral artery (49%), superficial femoral artery (11%) and external iliac artery (41%), with some cases injuring multiple vessels. Closure devices were found in the subcutaneous tissue (26%), anterior wall (37%), posterior wall (11%), intra-arterial (11%), closing the anterior to the posterior wall (16%), and in the inguinal ligament (5%). Injuries included tears (11%), dissections (38%), and vessel rupture (19%). The majority of repairs were done primarily (64%), with patch (28%) and bypass (8%) less frequently. Four patients died perioperatively (11%), 2 from hemorrhage, 1 from cardiac arrest, and 1 from progressive respiratory disease. CONCLUSIONS Access complications during TAVI procedures predispose complex patients to increased risk of morbidity and mortality. Careful patient selection, proper access techniques, and performing high risk patients in the operating suite with vascular surgery are fundamental in minimizing complications.
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Affiliation(s)
- Nicholas Sinclair
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alexa Mordhorst
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Gary K Yang
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - P Shaun MacDonald
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Sidhu
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - John D S Reid
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
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16
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TAVR: A Review of Current Practices and Considerations in Low-Risk Patients. J Interv Cardiol 2020; 2020:2582938. [PMID: 33447165 PMCID: PMC7781688 DOI: 10.1155/2020/2582938] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 11/17/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe, symptomatic, aortic stenosis (AS) in patients of all risk categories and now comprises 12.5% of all aortic valve replacements. TAVR is a less invasive alternative to traditional surgical aortic valve replacement (SAVR), with equivalent or superior outcomes. The use of TAVR has increased rapidly. The success and increase in use of TAVR are a result of advances in technology, greater operator experience, and improved outcomes. Indications have recently expanded to include patients considered to be at low risk for SAVR. While TAVR outcomes have improved, remaining challenges include the management of coexistent coronary artery disease, prevention of periprocedural stroke, and issue of durability. These issues are even more relevant for low-risk, younger patients.
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17
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Joseph J, Kotronias RA, Estrin-Serlui T, Cahill TJ, Kharbanda RK, Newton JD, Grebenik C, Dawkins S, Banning AP. Safety and operational efficiency of restructuring and redeploying a transcatheter aortic valve replacement service during the COVID-19 pandemic: The Oxford experience. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 31:26-31. [PMID: 33309231 PMCID: PMC7836266 DOI: 10.1016/j.carrev.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The risk of nosocomial COVID-19 infection for vulnerable aortic stenosis patients and intensive care resource utilization has led to cardiac surgery deferral. Untreated severe symptomatic aortic stenosis has a dismal prognosis. TAVR offers an attractive alternative to surgery as it is not reliant on intensive care resources. We set out to explore the safety and operational efficiency of restructuring a TAVR service and redeploying it to a new non-surgical site during the COVID-19 pandemic. METHODS The institutional prospective service database was retrospectively interrogated for the first 50 consecutive elective TAVR cases prior to and after our institution's operational adaptations for the COVID-19 pandemic. Our endpoints were VARC-2 defined procedural complications, 30-day mortality or re-admission and service efficiency metrics. RESULTS The profile of patients undergoing TAVR during the pandemic was similar to patients undergoing TAVR prior to the pandemic with the exception of a lower mean age (79 vs 82 years, p < 0.01) and median EuroScore II (3.1% vs 4.6%, p = 0.01). The service restructuring and redeployment contributed to the pandemic-mandated operational efficiency with a reduction in the distribution of pre-admission hospital visits (3 vs 3 visits, p < 0.001) and the time taken from TAVR clinic to procedure (26 vs 77 days, p < 0.0001) when compared to the pre-COVID-19 service. No statistically significant difference was noted in peri-procedural complications and 30-day outcomes, while post-operative length of stay was significantly reduced (2 vs 3 days, p < 0.0001) when compared to pre-COVID-19 practice. CONCLUSIONS TAVR service restructuring and redeployment to align with pandemic-mandated healthcare resource rationalization is safe and feasible.
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Affiliation(s)
- Jubin Joseph
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rafail A Kotronias
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | | | - Thomas J Cahill
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rajesh K Kharbanda
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - James D Newton
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Catherine Grebenik
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sam Dawkins
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian P Banning
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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18
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Musumeci G, Albani S. US-guided vascular access and left ventricular rapid pacing in TAVR: Two simple points that may improve patients' outcomes. Catheter Cardiovasc Interv 2020; 96:440-441. [PMID: 32797746 DOI: 10.1002/ccd.29160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/11/2022]
Abstract
The use of US-guided vascular access and left ventricular rapid pacing could significantly reduce TAVR-related complications. This study suggests simple tricks to keep the procedure safer. Further multicenter studies are needed to confirm the present data.
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Affiliation(s)
- Giuseppe Musumeci
- Department of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
| | - Stefano Albani
- Department of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
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19
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Lauck S, Forman J, Borregaard B, Sathananthan J, Achtem L, McCalmont G, Muir D, Hawkey MC, Smith A, Højberg Kirk B, Wood DA, Webb JG. Facilitating transcatheter aortic valve implantation in the era of COVID-19: Recommendations for programmes. Eur J Cardiovasc Nurs 2020; 19:537-544. [PMID: 32498556 PMCID: PMC7717283 DOI: 10.1177/1474515120934057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The COVID-19 pandemic continues to significantly impact the treatment of people living with aortic stenosis, and access to transcatheter aortic valve implantation. Transcatheter aortic valve implantation (TAVI) programmes require unique coordinated processes that are currently experiencing multiple disruptions and are guided by rapidly evolving protocols. We present a series of recommendations for TAVI programmes to adapt to the new demands, based on recent evidence and the international expertise of nurse leaders and collaborators in this field. Although recommended in most guidelines, the uptake of the role of the TAVI programme nurse is uneven across international regions. COVID-19 is further highlighting why a nurse-led central point of coordination and communication is a vital asset for patients and programmes. We propose an alternative streamlined evaluation pathway to minimize patients' pre-procedure exposure to the hospital environment while ensuring appropriate treatment decision and shared decision-making. The competing demands created by COVID-19 require vigilant wait list management, with risk stratification, telephone surveillance and optimized triage and prioritization. A minimalist approach with close scrutiny of all parts of the procedure has become an imperative to avoid any complications and ensure patients' accelerated recovery. Lastly, we outline a nurse-led protocol of rapid mobilization and reconditioning as an effective strategy to facilitate safe next-day discharge home. As the pandemic abates, TAVI programmes must facilitate access to care without compromising patient safety, enable hospitals to manage the competing demands created by COVID-19 and establish new processes to support patients living with valvular heart disease.
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Affiliation(s)
- Sandra Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - Jacqueline Forman
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - Leslie Achtem
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | | | - Douglas Muir
- James Cook University Hospital, Middlesbrough, UK
| | | | - Amanda Smith
- Hamilton Health Sciences Centre, McMaster University, Hamilton, Canada
| | - Bettina Højberg Kirk
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - David A Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver Canada
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20
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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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