1
|
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).
Collapse
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.
| |
Collapse
|
2
|
Alternative Access for Transcatheter Aortic Valve Replacement: A Comprehensive Review. Interv Cardiol Clin 2021; 10:505-517. [PMID: 34593113 DOI: 10.1016/j.iccl.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Transfemoral is the most widely used access to perform transcatheter aortic valve replacement (TAVR). However, alternative access is needed in up to 21% of patients with TAVR because of a myriad of factors. The authors provide a comprehensive review on alternative access for TAVR, discussing the relevant data and providing the pros and cons of each access route.
Collapse
|
3
|
Morello A, Corcione N, Ferraro P, Cimmino M, Pepe M, Cassese M, Frati G, Biondi-Zoccai G, Giordano A. The best way to transcatheter aortic valve implantation: From standard to new approaches. Int J Cardiol 2020; 322:86-94. [PMID: 32814109 DOI: 10.1016/j.ijcard.2020.08.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/07/2020] [Accepted: 08/07/2020] [Indexed: 02/08/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is a safe and beneficial treatment for patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. The safety of the procedure continues to improve thanks to more refined procedural approaches and devices but, also and above all, to the accrual of the procedural knowledge and expertise by the operators. The diversification of the approaches and the possibility to tailor the treatment on the individual needs and anatomical features of the patients allows a rapid learning curve in the management of even complications. Indeed, there are several approaches with which TAVI can be carried out: transfemoral arterial, subclavian, transcarotid, transaortic, transaxillary, transapical, and through right anterior thoracotomy. Although transfemoral venous TAVI is less common, it has already have been carried out using caval-aortic punctures. This field is rapidly evolving, and it will be of paramount importance for interventional cardiologists and cardiothoracic surgeons to keep up to date with further developments. This review intends to give an in-depth and update overview of both conventional and innovative TAVI approaches, with the scope to highlight the relevant advantages, major disadvantages, safety aspects and techniques.
Collapse
Affiliation(s)
- Alberto Morello
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy.
| | - Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Paolo Ferraro
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Cimmino
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency and OrganTransplantation, University of Bari, Bari, Italy
| | - Mauro Cassese
- Heart Surgery Department, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; IRCCS NEUROMED, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| |
Collapse
|
4
|
Panoulas V, Monteagudo-Vela M, Kalogeras K, Simon A. Subclavian Impella 5.0 to the rescue in a non-ST elevation myocardial infarction patient requiring unprotected left main rotablation: A case report. World J Cardiol 2020; 12:155-160. [PMID: 32431786 PMCID: PMC7215966 DOI: 10.4330/wjc.v12.i4.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Often in patients with significant three-vessel or left main disease there is coexistent significant peripheral disease rendering them poor candidates for percutaneous left ventricular support during revascularization. Evidence on the management of such cases is limited.
CASE SUMMARY We describe a case of such a patient with critical distal left main disease and chronically occluded right coronary artery who presented with chest pain and a non-ST elevation myocardial infarction and had significantly impaired left ventricular function. With the aid of our cardiothoracic surgeons a cut down subclavian Impella 5.0 was inserted and high risk rotablation percutaneous coronary intervention carried out successfully.
CONCLUSION This case highlights the need for cross-specialty collaborations in such high-risk cases were alternative access is needed for insertion of large bore mechanical circulatory support devices.
Collapse
Affiliation(s)
- Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, United Kingdom
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College, London SW7 2BU, United Kingdom
| | - María Monteagudo-Vela
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, United Kingdom
| | - Konstantinos Kalogeras
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, United Kingdom
| | - Andre Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, United Kingdom
| |
Collapse
|