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Sheng W, Dai H, Zheng R, Aihemaiti A, Liu X. An Updated Comprehensive Review of Existing Transcatheter Aortic Valve Replacement Access. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10484-z. [PMID: 39186224 DOI: 10.1007/s12265-024-10484-z] [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: 10/06/2023] [Accepted: 01/18/2024] [Indexed: 08/27/2024]
Abstract
For the past 20 years, transcatheter aortic valve replacement (TAVR) has been the treatment of choice for symptomatic aortic stenosis. The transfemoral (TF) access is considered the gold standard approach for TAVR. However, TF-TAVR cannot be performed in some patients; thus, alternative accesses are required. Our review paper generalises the TAVR accesses currently available, including the transapical, transaortic, trans-subclavian/axillary, transcarotid, transcaval, and suprasternal approaches. Their advantages and disadvantages have been analysed. Since there is no standard recommendation for an alternative approach, access selection depends on the expertise of the local cardiac team, patient characteristics, and access properties. Each TAVR centre is recommended to master a minimum of one non-TF access alternative. Of note, more evidence is required to delve into the clinical outcomes of each approach, at both early and long-term (Figure 1).
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Affiliation(s)
- Wenjing Sheng
- Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310009
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310058
| | - Hanyi Dai
- Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310009
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310058
| | - Rongrong Zheng
- Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310009
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310058
| | - Ailifeire Aihemaiti
- Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310009
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310058
| | - Xianbao Liu
- Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310009.
- Internal Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310058.
- Binjiang Institute of Zhejiang University, Hangzhou, 310052, Zhejiang, China.
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Domoto S, Yamaguchi J, Tsuchiya K, Inagaki Y, Nakamae K, Hirota M, Arashi H, Hanafusa N, Hoshino J, Niinami H. Minimum-incision transsubclavian transcatheter aortic valve replacement with balloon-expandable valve for dialysis patients. J Cardiol 2024; 84:93-98. [PMID: 38215966 DOI: 10.1016/j.jjcc.2024.01.001] [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: 10/01/2023] [Revised: 11/21/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Dialysis patients undergoing transcatheter aortic valve replacement (TAVR) face increased risk and have poorer outcomes than non-dialysis patients. Moreover, TAVR in dialysis patients using an alternative approach is considered extremely risky and little is known about the outcomes. We routinely perform minimum-incision transsubclavian TAVR (MITS-TAVR), which is contraindicated for transfemoral (TF) TAVR. This study aimed to evaluate the outcomes of MITS-TAVR compared with those of TF-TAVR in dialysis patients. METHODS This single-center, observational study included 79 consecutive dialysis patients who underwent MITS-TAVR (MITS group, n = 22) or TF-TAVR (TF group, n = 57) under regional anesthesia. RESULTS The rates of peripheral artery disease (MITS vs. TF, 72.7 % vs. 26.3 %; p < 0.01), shaggy aortas (MITS vs. TF, 63.6 % vs. 5.26 %; p < 0.01), and tortuous aortas (MITS vs. TF, 13.6 % vs. 1.75 %; p = 0.031) were significantly higher in the MITS group. The 30-day mortality was 2.53 % and comparable between the two groups (MITS vs. TF, 4.54 % vs. 1.75 %; p = 0.479). In the MITS group, 14 patients had ipsilateral dialysis fistulas, and three patients had patent in situ ipsilateral internal thoracic artery grafts; however, no vascular complications were observed. Kaplan-Meier survival curves for the two groups showed no significant difference in the survival rate (at 2 years; MITS vs. TF, 77.3 % vs. 68.8 %; p = 0.840) and freedom from cardiovascular mortality (at 2 years; MITS vs. TF, 90.9 % vs. 96.5 %; p = 0.898). The multivariable Cox proportional hazard model also indicated that survival in the MITS group was not significantly different from that in the TF group (hazard ratio 1.48; 95 % confidence interval, 0.77-2.85, p = 0.244). The patency rate of ipsilateral dialysis fistula was 100 % during follow-up. CONCLUSION The outcome of MITS-TAVR was comparable to that of TF-TAVR in dialysis patients, despite the higher risk of patient characteristics.
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Affiliation(s)
- Satoru Domoto
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Yusuke Inagaki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kosuke Nakamae
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masataka Hirota
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Arashi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Rohm CL, Pasrija C, Raj LM. Percutaneous axillary extracorporeal membrane oxygenation supported complex left main bifurcation percutaneous coronary intervention. Catheter Cardiovasc Interv 2024; 104:54-57. [PMID: 38796712 DOI: 10.1002/ccd.31113] [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: 01/17/2024] [Revised: 04/16/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
Abstract
A 66-year-old man with multiple comorbidities including severe peripheral artery disease and heart failure with reduced ejection fraction presented with complex coronary artery disease with an elevated Society of Thoracic Surgeons Predicted Risk of Mortality for coronary artery bypass grafting and a Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score of 18. With a multidisciplinary heart team approach, the patient successfully underwent percutaneous axillary venoarterial extracorporeal membrane oxygenation (VA-ECMO) supported high-risk percutaneous coronary intervention of a heavily calcified left main bifurcation lesion. Given the patient's peripheral artery disease, alternative arterial access for ECMO cannulation was performed percutaneously via the right axillary artery. Additionally, adequate coronary calcium modification was critical to successful stenting of a heavily calcified left main bifurcation. This case highlights a novel approach to obtaining alternative arterial access for ECMO cannulation and emphasizes the importance of calcium modification to achieve excellent stent results.
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Affiliation(s)
- Charlene L Rohm
- Division of Interventional Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chetan Pasrija
- Division of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Leah M Raj
- Division of Interventional Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Gerfer S, Großmann C, Gablac H, Elderia A, Wienemann H, Krasivskyi I, Mader N, Lee S, Mauri V, Djordjevic I, Adam M, Kuhn E, Baldus S, Eghbalzadeh K, Wahlers T. Low Left-Ventricular Ejection Fraction as a Predictor of Intraprocedural Cardiopulmonary Resuscitation in Patients Undergoing Transcatheter Aortic Valve Implantation. Life (Basel) 2024; 14:424. [PMID: 38672696 PMCID: PMC11051090 DOI: 10.3390/life14040424] [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: 02/04/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (AVR) for patients with moderate-to-high perioperative risk. Periprocedural TAVR complications decrease with growing expertise of implanters. Nevertheless, TAVR can still be accompanied by life-threatening adverse events such as intraprocedural cardiopulmonary resuscitation (CPR). This study analyzed the role of a reduced left-ventricular ejection fraction (LVEF) in intraprocedural complications during TAVR. Perioperative and postoperative outcomes from patients undergoing TAVR in a high-volume center (600 cases per year) were analyzed retrospectively with regard to their left-ventricular ejection fraction. Patients with a reduced left-ventricular ejection fraction (EF ≤ 40%) faced a significantly higher risk of perioperative adverse events. Within this cohort, patients were significantly more often in need of mechanical ventilation (35% vs. 19%). These patients also underwent CPR (17% vs. 5.8%), defibrillation due to ventricular fibrillation (13% vs. 5.4%), and heart-lung circulatory support (6.1% vs. 2.5%) more often. However, these intraprocedural adverse events showed no significant impact on postoperative outcomes regarding in-hospital mortality, stroke, or in-hospital stay. A reduced preprocedural LVEF is a risk factor for intraprocedural adverse events. With respect to this finding, the identified patient cohort should be treated with more caution to prevent intraprocedural incidents.
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Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Clara Großmann
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Hannah Gablac
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Ahmed Elderia
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Hendrik Wienemann
- Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (V.M.)
| | - Ihor Krasivskyi
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Samuel Lee
- Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (V.M.)
| | - Victor Mauri
- Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (V.M.)
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Matti Adam
- Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (V.M.)
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Stephan Baldus
- Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (V.M.)
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
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Effect of V-Shaped Groove Microstructure on Blood Flow Resistance in Bionic Artificial Blood Vessels. Appl Bionics Biomech 2023. [DOI: 10.1155/2023/7861408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
This study aims to investigate the blood flow in bionic artificial blood vessels and to reduce the resistance to blood flow, the drag reduction characteristics of V-shaped groove drag reduction microstructures in artificial blood vessel structures were investigated in depth. By varying the parameters of incoming flow velocity, groove width, and groove depth, the effect of various variable conditions on the drag reduction effect of the grooves was investigated, and the flow field characteristics and drag reduction effect of the V-shaped groove microstructure in the artificial blood vessel were obtained. A detailed analysis of the effect of velocity and groove size on the drag reduction effect of the groove was also carried out to demonstrate the drag reduction mechanism of the V-shaped groove microstructure and to summarize the variation law of the drag reduction rate of the V-shaped groove. The results show that the resistance reduction rate of the V-shaped groove microstructure decreases with the increase of blood flow velocity, increases with the increase of groove width, and increases and then decreases with the increase of groove depth. The velocity range used in this paper is 0.3–0.6 m/s, the groove width varies from 0 to 0.3 mm, and the groove depth varies from 0 to 0.3 mm.
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Wong CK, Chiu ACHO, Chan KYE, Sze SY, Tam FCC, Un KC, Lam SCC, Tse HF. Advances in technology and techniques for transcatheter aortic valve replacement with concomitant peripheral arterial disease. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:959249. [PMID: 36062263 PMCID: PMC9433652 DOI: 10.3389/fmedt.2022.959249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
Aortic stenosis (AS) is a prevalent disease affecting 3.7% of the adult population aged 65 or above. In the past, surgical aortic valve replacement (SAVR) was the only definitive therapy available for the treatment of severe AS. Owing to the invasive nature of open-heart surgery, patients with advanced age and frailty could not benefit from SAVR. The advent of transcatheter aortic valve replacement (TAVR) in the past decade has offered an alternative treatment option for patients with severe AS, particularly those who are deemed to have high surgical risks. Nevertheless, a large proportion of patients also have concomitant peripheral arterial disease (PAD), which increases the risk of peri-procedural vascular complication, and precludes the possibility of transfemoral TAVR owing to inadequate luminal size for delivery system deployment. In this review, the prevalence and outcome of TAVR patients with PAD will be discussed. Furthermore, novel technologies and techniques that enable TAVR to be safely performed using transfemoral or alternative access in patients with severe PAD will be reviewed.
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