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Tom S, Tully A, Kikuchi Y, Crawford K, Binongo J, Wei JW, Gleason P, Xie J, Devireddy CM, Grubb KJ. Peripheral intravascular lithotripsy to facilitate transfemoral transcatheter aortic valve replacement - Defining optimal treatable peripheral arterial disease burden. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00582-7. [PMID: 39095289 DOI: 10.1016/j.carrev.2024.07.005] [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: 03/11/2024] [Revised: 06/27/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Transfemoral transcatheter aortic valve replacement (TF-TAVR) has proven superior to alternative access. However, some patients evaluated for TF-TAVR are unfit secondary to peripheral arterial disease (PAD). Peripheral intravascular lithotripsy (IVL) can facilitate femoral access. This study aimed to characterize optimal lesions that can be treated with IVL. METHODS Single-center, retrospective analysis of an institutional database, queried from 1/2018 through 7/2023 for all patients who underwent TAVR. Patients who received IVL-facilitated transfemoral access were analyzed. RESULTS Of 2862 TAVR cases identified, 92 (3.2 %) underwent lithotripsy. The IVL-facilitated cohort had a mean age of 78 ± 9.2 years and 45 % were female. The right common iliac artery was most treated (47). Most IVL was performed with 7-mm balloons (73.9 %). All cases were successful. 30-day mortality was 1.1 % (1/92). CONCLUSIONS In our cohort, complications after IVL-facilitated TF-TAVR were more common with small vessel diameter (≤4.7 mm), significant luminal loss (>50 % stenosis), and heavy calcium burden (arc calcification >180°). The findings support the use of IVL to expand the population of patients who can undergo TF-TAVR without the increased risks associated with the various forms of alternative access. SUMMARY FOR ANNOTATED TABLE OF CONTENTS IVL-facilitated TF-TAVR is safe and feasible. Despite its introduction to TAVR clinical practice in 2018, IVL-facilitated TF-TAVR is not regularly performed and could increase the population of patients eligible for TF-TAVR.
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Affiliation(s)
- Stephanie Tom
- Department of Surgery, Emory University, Atlanta, GA, USA.
| | - Andy Tully
- University of Maryland Department of Surgery, Baltimore, MD, USA
| | - Yuta Kikuchi
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA; Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | | | - José Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University, Atlanta, GA, USA
| | - Jane Wenjing Wei
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University, Atlanta, GA, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA; Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Joe Xie
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA; Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Chandan M Devireddy
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA; Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA; Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
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Basman C, Kodra A, Mustafa A, Wang D, Cinelli M, Onyebeke K, Rutkin B, Mehla P, Maniatis G, Pirelli L, Goldberg Y, Liu S, Uttar S, Wilson S, Kalimi R, Brinster D, Gandotra P, Koss E, Meraj P, Mihelis E, Supariwala A, Hartman A, Scheinerman SJ, Kliger C. Collagen-Based Bailout Compared to Suture-Mediated Vascular Closure Alone During Transcatheter Aortic Valve Replacement. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101929. [PMID: 39132601 PMCID: PMC11307645 DOI: 10.1016/j.jscai.2024.101929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 08/13/2024]
Abstract
Background Hemostasis for transfemoral transcatheter aortic valve replacement (TAVR) is typically achieved using a suture-mediated vascular closure device (VCD) prior to large-bore sheath insertion (preclosure technique). Recently, the addition of a hybrid closure technique using a preclose technique with the addition of a collagen-plug VCD after sheath removal in cases of failed hemostasis has been utilized. Methods Data were collected from the Northwell TAVR registry, including 3 high-volume TAVR centers. We evaluated a preclose strategy with suture-mediated vascular closure alone ("legacy strategy") and standard bailout techniques versus a contemporary hybrid strategy of suture-mediated closure with collagen-mediated closure bailout. The primary end point was major or minor vascular complications as defined by the VARC-3 criteria. Results A total of 1327 patients were included, of which 791 patients underwent TAVR with suture-mediated closure alone and 536 with contemporary strategy. The primary end point (major or minor vascular complication) was lower in the contemporary strategy (5.44% vs 1.31%; P < .001). Both minor (3.92% vs 1.12%; P = .002) and major (1.14% vs 0.19%; P = .0196) vascular complications were reduced and the total length of stay was less in the contemporary strategy (median of 3 days vs 2 days; P < .0001). Using multivariable analysis, we observed that vascular management strategy significantly improved the composite primary outcome when adjusted for sheath size, peripheral artery disease, carotid disease, and site of procedure. In the contemporary group, bailout collagen-plug VCD with an Angio-Seal (Terumo Medical) was used in 68 patients (12.69%) and bailout MANTA (Teleflex) was required in 4 patients (0.75%). There were no major or minor vascular complications among the patients who received bailout collagen-plug VCD. Conclusions A contemporary hybrid strategy of suture-mediated closure with collagen-mediated closure bailout reduces the risk of vascular complications among patients undergoing transfemoral TAVR.
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Affiliation(s)
- Craig Basman
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Arber Kodra
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Ahmad Mustafa
- Department of Cardiovascular & Thoracic Surgery, Staten Island University Hospital/Northwell Health, New York, New York
| | - Denny Wang
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Michael Cinelli
- Department of Cardiovascular & Thoracic Surgery, Staten Island University Hospital/Northwell Health, New York, New York
| | - Kenenna Onyebeke
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Bruce Rutkin
- Department of Cardiovascular & Thoracic Surgery, Northshore University Hospital/Northwell Health, New York, New York
| | - Priti Mehla
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Gregory Maniatis
- Department of Cardiovascular & Thoracic Surgery, Staten Island University Hospital/Northwell Health, New York, New York
| | - Luigi Pirelli
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Ythan Goldberg
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Shangyi Liu
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Sridhar Uttar
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Sean Wilson
- Department of Cardiovascular & Thoracic Surgery, Northshore University Hospital/Northwell Health, New York, New York
| | - Robert Kalimi
- Department of Cardiovascular & Thoracic Surgery, Southside Hospital/Northwell Health, New York, New York
| | - Derek Brinster
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Puneet Gandotra
- Department of Cardiovascular & Thoracic Surgery, Northshore University Hospital/Northwell Health, New York, New York
| | - Elana Koss
- Department of Cardiovascular & Thoracic Surgery, Northshore University Hospital/Northwell Health, New York, New York
| | - Perwaiz Meraj
- Department of Cardiovascular & Thoracic Surgery, Northshore University Hospital/Northwell Health, New York, New York
| | - Efstathia Mihelis
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Azhar Supariwala
- Department of Cardiovascular & Thoracic Surgery, Southside Hospital/Northwell Health, New York, New York
| | - Alan Hartman
- Department of Cardiovascular & Thoracic Surgery, Northshore University Hospital/Northwell Health, New York, New York
| | - S. Jacob Scheinerman
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Chad Kliger
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Northwell TAVR Investigators
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
- Department of Cardiovascular & Thoracic Surgery, Staten Island University Hospital/Northwell Health, New York, New York
- Department of Cardiovascular & Thoracic Surgery, Northshore University Hospital/Northwell Health, New York, New York
- Department of Cardiovascular & Thoracic Surgery, Southside Hospital/Northwell Health, New York, New York
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Terré JA, Torrado J, George I, Harari R, Cox-Alomar PR, Villablanca PA, Faillace RT, Granada JF, Dangas G, Garcia MJ, Latib A, Wiley J. Aortic Stenosis Management in Patients With Acute Hip Fracture. JACC. ADVANCES 2024; 3:100912. [PMID: 38939644 PMCID: PMC11198465 DOI: 10.1016/j.jacadv.2024.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/04/2023] [Indexed: 06/29/2024]
Abstract
The treatment of severe aortic stenosis (SAS) has evolved rapidly with the advent of minimally invasive structural heart interventions. Transcatheter aortic valve replacement has allowed patients to undergo definitive SAS treatment achieving faster recovery rates compared to valve surgery. Not infrequently, patients are admitted/diagnosed with SAS after a fall associated with a hip fracture (HFx). While urgent orthopedic surgery is key to reduce disability and mortality, untreated SAS increases the perioperative risk and precludes physical recovery. There is no consensus on what the best strategy is either hip correction under hemodynamic monitoring followed by valve replacement or preoperative balloon aortic valvuloplasty to allow HFx surgery followed by valve replacement. However, preoperative minimalist transcatheter aortic valve replacement may represent an attractive strategy for selected patients. We provide a management pathway that emphasizes an early multidisciplinary approach to optimize time for hip surgery to improve orthopedic and cardiovascular outcomes in patients presenting with HFx-SAS.
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Affiliation(s)
- Juan A. Terré
- Section of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Juan Torrado
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Isaac George
- Structural Heart and Valve Center, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Rafael Harari
- Department of Cardiology, Bellevue Hospital, New York, New York, USA
| | - Pedro R. Cox-Alomar
- Department of Cardiology, Louisiana State University, New Orleans, Louisiana, USA
| | | | - Robert T. Faillace
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Bronx, New York, USA
| | | | - George Dangas
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mario J. Garcia
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - José Wiley
- Section of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
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Rosseel L, Montarello NJ, Nuyens P, Tirado-Conte G, Quagliana A, Cornelis K, Floré V, Rosseel M, Bieliauskas G, Sondergaard L, De Backer O. A systematic algorithm for large-bore arterial access closure after TAVI: the TAVI-MultiCLOSE study. EUROINTERVENTION 2024; 20:e354-e362. [PMID: 37982158 PMCID: PMC10949328 DOI: 10.4244/eij-d-23-00725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Despite transcatheter aortic valve implantation (TAVI) having become a routine procedure, access site bleeding and vascular complications are still a concern which contribute to procedure-related morbidity and mortality. AIMS The TAVI-MultiCLOSE study aimed to assess the safety and efficacy of a new vascular closure algorithm for percutaneous large-bore arterial access closure following transfemoral (TF)-TAVI. METHODS All consecutive TF-TAVI cases in which the MultiCLOSE vascular closure algorithm was used were prospectively included in a multicentre, observational study. This stepwise algorithm entails the reinsertion of a 6-8 Fr sheath (primary access) following the initial preclosure with one or two suture-based vascular closure devices (VCDs). This provides the operator with the opportunity to perform a quick and easy angiographic control and tailor the final vascular closure with either an additional suture- or plug-based VCD, or neither of these. RESULTS Among 630 patients who underwent TF-TAVI utilising the MultiCLOSE algorithm, complete arterial haemostasis was achieved in 616 patients (98%). VCD failure occurred in 14 patients (2%), treated with either balloon inflation (N=1), covered stent (N=12) or surgical repair (N=1). Overall, this vascular closure approach resulted in a minor and major vascular complication rate of 2.2% and 0.6%, respectively. At 30 days, only one new minor vascular complication (0.2%) was noted. In-hospital and 30-day all-cause mortality rates were 0.2% and 1.0%, respectively. CONCLUSIONS Use of the MultiCLOSE vascular closure algorithm was demonstrated to contribute to an easy, safe, efficacious and durable vascular closure after TF-TAVI, resulting in a major vascular complication rate of less than 1%.
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Affiliation(s)
- Liesbeth Rosseel
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Cardiology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - Nicholas J Montarello
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Angelo Quagliana
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristoff Cornelis
- Cardiology Department, Algemeen Ziekenhuis Maria Middelares, Ghent, Belgium
| | - Vincent Floré
- Cardiology Department, Algemeen Ziekenhuis Maria Middelares, Ghent, Belgium
| | - Michael Rosseel
- Cardiology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Costa G, Giannini C, Mazzola M, Angelillis M, Primerano C, Spontoni P, Stazzoni L, Faggioni L, Neri E, De Carlo M, Petronio AS. Evolving Paradigms in Transcatheter Aortic Valve Replacement: Results from a High-Volume, Single Center Experience. Am J Cardiol 2024; 212:118-126. [PMID: 38036051 DOI: 10.1016/j.amjcard.2023.11.048] [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: 08/07/2023] [Revised: 10/19/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
Given the expanding indications toward younger patients at lower surgical risk, transcatheter aortic valve replacement (TAVR) simplification and streamlining are gaining increasing importance. Patients who underwent TAVR from the year 2015 to 2020 were prospectively enrolled. The patients were divided in time tertiles according to the date of intervention. Data on preprocedural planning, including coronary computed tomography angiography (CCTA), procedures, and outcomes, were compared between the time tertiles. A total of 771 consecutive patients from a single institution were enrolled. We observed a trend toward the use of a fully percutaneous versus surgical approach for the index access, left radial artery versus contralateral femoral artery for the secondary access, and left ventricular pacing on the stiff guidewire versus right ventricular pacing. Immediate device success significantly increased, whereas the length of hospital stay decreased. Overall, approximately 60% of the total study population underwent CCTA instead of coronary angiography, with no adverse events. One-year survival rates significantly improved over time. A simplified TAVR approach was associated with better survival, whereas low baseline functional capacity, preexisting coronary artery disease, renal impairment, periprocedural blood transfusions, and paravalvular leak were related to worse outcomes. In conclusion, our study showed a constant tendency to procedure streamlining and improve procedural success and 1-year outcomes. A strategy based on CCTA allows sparing safely almost half of the preoperative invasive coronary angiography.
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Affiliation(s)
- Giulia Costa
- Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Cristina Giannini
- Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Matteo Mazzola
- Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco Angelillis
- Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Chiara Primerano
- Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Paolo Spontoni
- Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Laura Stazzoni
- Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Lorenzo Faggioni
- Department of Translational Research, Academic Radiology, University of Pisa, Pisa, Italy
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, Pisa, Italy
| | - Marco De Carlo
- Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Anna Sonia Petronio
- Cardiac Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Naoum I, Eitan A, Galili O, Hayeq H, Shiran A, Zissman K, Sliman H, Jaffe R. Strategy for Totally Percutaneous Management of Vascular Injury in Combined Transfemoral Transcatheter Aortic Valve Replacement and Endovascular Aortic Aneurysm Repair Procedures. Am J Cardiol 2023; 207:130-136. [PMID: 37738782 DOI: 10.1016/j.amjcard.2023.08.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/24/2023]
Abstract
Minimally invasive treatment of severe aortic stenosis by transcatheter aortic valve replacement (TAVR) and infrarenal abdominal aortic aneurysm by endovascular aortic aneurysm repair (EVAR) requires large-bore vascular access. These percutaneous transfemoral interventions may be performed as a combined procedure, however, vascular injury may necessitate surgical vascular repair. We implemented a strategy designed to enable percutaneous vascular repair, with stent-graft implantation, if necessary, after these combined procedures. We identified all combined percutaneous TAVR and EVAR procedures which were performed at our institution. Patient and procedural characteristics and clinical outcomes were analyzed. Six consecutive patients underwent total percutaneous combined TAVR and EVAR procedures. In all cases, TAVR was performed first and was followed by EVAR. Both common femoral arteries served as primary access sites for delivery of the implanted devices and hemostasis was achieved by deployment of vascular closure devices. Secondary access sites included the right brachial artery in all patients and superficial femoral arteries in 50% of the patients. In all cases an "0.014" 300-cm length "safety" wire was delivered to the common femoral artery or descending aorta by way of a secondary access site to facilitate stent graft delivery. Successful device implantation was achieved in all cases. Vascular closure device failure occurred in 2 patients and was treated by stent graft implantation by way of the brachial and superficial femoral arteries, without need for surgical vascular repair. A strategy designed to facilitate percutaneous vascular repair after combined EVAR and TAVR procedures may enable a truly minimally invasive procedure.
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Affiliation(s)
| | | | - Offer Galili
- Department of Vascular & Endovascular Surgery, Carmel Medical Center, Haifa, Israel
| | - Hashem Hayeq
- Department of Vascular & Endovascular Surgery, Carmel Medical Center, Haifa, Israel
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Quagliana A, Montarello NJ, Vanhaverbeke M, Willemen Y, Campens L, Sondergaard L, De Backer O. Orbital atherectomy to facilitate transfemoral transcatheter aortic valve implantation in patients with calcified iliofemoral arteries: a case series. Eur Heart J Case Rep 2023; 7:ytad310. [PMID: 37501711 PMCID: PMC10369203 DOI: 10.1093/ehjcr/ytad310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/11/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
Background The transfemoral (TF) approach drives most of the advantages of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement. Alternative accesses for TAVI are associated with higher complication rates, but are still considered in ∼5% of cases due to peripheral arterial disease (PAD). Percutaneous transluminal angioplasty can still allow TF-TAVI in selected cases with severe calcific PAD; however, ancillary techniques for calcium management are often needed. Case Summary Orbital atherectomy was selected to facilitate TF-TAVI in two patients with different degrees and aspects of calcific PAD. Pre-procedural computed tomography analysis was key to choose the most appropriate technique for calcium management. We describe our experience with a step-by-step procedural approach to orbital atherectomy-assisted TF-TAVI. Discussion PAD is not uncommon in patients affected by severe symptomatic aortic valve stenosis. Orbital atherectomy can still allow TF-TAVI in selected cases with severe calcific PAD. A meticulous patient selection and a standardized, step-wise procedural execution are mandatory to optimize outcomes.
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Affiliation(s)
- Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Istituto Cardiocentro Ticino, Università della Svizzera Italiana, Lugano, Switzerland
| | - Nicholas J Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Yannick Willemen
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Laurence Campens
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Sugiura A, Sudo M, Al-Kassou B, Shamekhi J, Silaschi M, Wilde N, Sedaghat A, Becher UM, Weber M, Sinning JM, Grube E, Nickenig G, Charitos EI, Zimmer S. Percutaneous trans-axilla transcatheter aortic valve replacement. Heart Vessels 2022; 37:1801-1807. [PMID: 35505257 PMCID: PMC9399016 DOI: 10.1007/s00380-022-02082-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
The left axillary artery is an attractive alternative access route for transcatheter aortic valve replacement (TAVR) and may provide better outcomes compared to other alternatives. Nevertheless, there remain concerns about vascular complications, lack of compressibility, and thorax-related complications. Between March 2019 and March 2021, 13 patients underwent transaxillary TAVR for severe aortic stenosis at the University Hospital Bonn. The puncture was performed with a puncture at the distal segment of the axillary artery through the axilla, with additional femoral access for applying a safety wire inside the axillary artery. Device success was defined according to the VARC 2 criteria. The study participants were advanced in age (77 ± 9 years old), and 54% were female, with an intermediate risk for surgery (STS risk score 4.7 ± 2.0%). The average diameter of the distal segment of the axillary artery was 5.8 ± 1.0 mm (i.e., the puncture site) and 7.6 ± 0.9 mm for the proximal axillary artery. Device success was achieved in all patients. 30-day major adverse cardiac and cerebrovascular events were 0%. With complete percutaneous management, stent-graft implantation was performed at the puncture site in 38.5% of patients. Minor bleeding was successfully managed with manual compression. Moreover, no thorax-related complications, hematomas, or nerve injuries were observed. Percutaneous trans-axilla TAVR was found to be feasible and safe. This modified approach may mitigate the risk of bleeding and serious complications in the thorax and be less invasive than surgical alternatives.
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Affiliation(s)
- Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Mitsumasa Sudo
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Ulrich Marc Becher
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Efstratios I Charitos
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
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9
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Eitan A, Sliman H, Shiran A, Jaffe R. Strategies for Facilitating Totally Percutaneous Transfemoral TAVR Procedures. J Clin Med 2022; 11:2104. [PMID: 35456197 PMCID: PMC9028438 DOI: 10.3390/jcm11082104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 02/01/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and should ideally be performed as a totally percutaneous procedure via the transfemoral (TF) approach. Peripheral vascular disease may impede valve delivery, and vascular access site complications are associated with adverse clinical outcome and increased mortality. We review strategies aimed to facilitate TF valve delivery in patients with hostile vascular anatomy and achieve percutaneous management of vascular complications.
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Affiliation(s)
| | | | | | - Ronen Jaffe
- Department of Cardiology, Carmel Medical Center, Haifa 3436212, Israel; (A.E.); (H.S.); (A.S.)
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10
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Sawaya FJ, Bajoras V, Vanhaverbeke M, Wang C, Bieliauskas G, Søndergaard L, De Backer O. Intravascular Lithotripsy-Assisted Transfemoral TAVI: The Copenhagen Experience and Literature Review. Front Cardiovasc Med 2021; 8:739750. [PMID: 34631837 PMCID: PMC8492918 DOI: 10.3389/fcvm.2021.739750] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is currently an established therapy for elderly patients with symptomatic severe aortic valve stenosis across all surgical risk categories. Access is an important aspect when planning for and performing TAVI. The superiority of a transfemoral (TF) approach compared to a transthoracic (transapical, direct aortic) approach has been demonstrated in several studies. Recently, the introduction of intravascular lithotripsy (IVL) has made it possible to treat patients with calcified iliofemoral disease by TF approach. This article aimed to provide a comprehensive overview on the following aspects: (1) preprocedural planning for IVL-assisted TF-TAVI; (2) procedural aspects in IVL-assisted TF-TAVI; (3) outcomes of IVL-assisted TF-TAVI in an experienced TAVI center; and (4) literature review and discussion of this new emerging approach.
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Affiliation(s)
- Fadi J Sawaya
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vilhelmas Bajoras
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Wang
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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11
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Bi G, Wang Q, Xiong G, Chen J, Luo D, Deng J, Qin X. Is percutaneous access superior to cutdown access for endovascular abdominal aortic aneurysm repair? A meta-analysis. Vascular 2021; 30:825-833. [PMID: 34259113 DOI: 10.1177/17085381211032765] [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: 11/16/2022]
Abstract
OBJECTIVE The objective is to investigate whether percutaneous access (pEVAR) is superior to cutdown access (cEVAR) in terms of safety and efficacy during endovascular repair of abdominal aortic aneurysms (AAAs). METHODS We searched PubMed, Embase, and Cochrane Library from January 1999 to December 2020 for studies reporting on the comparison between percutaneous and cutdown techniques for endovascular repair of AAAs. Outcomes evaluated were technical success rates, access site-related complications and operative time, and hospital stay. RESULTS Four randomized controlled trials and nine observational studies with a total of 1683 patients comprising 2715 groin accesses were eligible for the meta-analysis. pEVAR was associated with a lower risk of overall complications (odds ratio (OR) = 0.63; p = .005) and seroma/lymphorrhea (OR, 0.18; p = .0001) and shortened operation time (MD = -39.04; p = .002) and the length of hospital stay (MD = -0.75; p < .00001) compared with cEVAR. The technical success rate for pEVAR was 95.1% (694/729), with an overall OR of 0.27 (95% CI 0.14-0.55, p = .0003) comparing pEVAR with cEVAR. Furthermore, pEVAR did not increase the risk of site infection, femoral artery thrombosis, postoperative hematoma, nerve injury, dissection, and bleeding. CONCLUSION Percutaneous endovascular aneurysm repair is a safe and effective method for the treatment of AAA. It reduces the risk of overall complications and shortens the operation time and hospital stay. The technical success rate of pEVAR is lower than that of cEVAR, which may be linked to the selection of patients, operator experience, and the use of ultrasound. Large definitive trials are required to draw robust conclusions.
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Affiliation(s)
- Guoshan Bi
- Department of Vascular Surgery, 117742The First Affiliated Hospital of Guangxi Medical University, Guangxi, China.,Department of Vascular Surgery, 575432The Second Affiliated Hospital of University of South China, Hunan Province, China
| | - Quanwen Wang
- Department of Vascular Surgery, 575432The Second Affiliated Hospital of University of South China, Hunan Province, China
| | - Guozuo Xiong
- Department of Vascular Surgery, 575432The Second Affiliated Hospital of University of South China, Hunan Province, China
| | - Jie Chen
- Department of Vascular Surgery, 575432The Second Affiliated Hospital of University of South China, Hunan Province, China
| | - Dongyang Luo
- Department of Vascular Surgery, 117742The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Jiangbei Deng
- Department of Vascular Surgery, 117742The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Xiao Qin
- Department of Vascular Surgery, 117742The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
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12
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Wilkins B, Bielauskas G, Costa G, Fukutomi M, Søndergaard L, De Backer O. Percutaneous Transaxillary versus Surgically-Assisted Transsubclavian TAVR: A Single Center Experience. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2020.1849882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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