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Cheema T, Venero C, Champaneria S, Younas S, Hadeed Khan MA, Anjum I, Ijaz U, Haider S, Akbar MS, Abdul-Waheed M, Saleem S. Systematic review and meta-analysis comparing Manta device and Perclose device for closure of large bore arterial access. J Vasc Access 2024:11297298231222314. [PMID: 38189215 DOI: 10.1177/11297298231222314] [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: 01/09/2024] Open
Abstract
Data comparing MANTA device with Perclose device for large bore arterial access closure is limited. We performed meta-analysis to compare safety and efficacy of the two devices in large (⩾14 Fr sheath) arteriotomy closure post-TAVR. Relevant studies were identified via PubMed, Cochrane, and EMBASE databases until June, 2022. Data was analyzed using random effect model to calculate relative odds of VARC-2 defined access-site complications and short-term (in-hospital or 30-day) mortality. A total of 12 studies (2 RCT and 10 observational studies) comprising 2339 patients were included. The odds of major vascular complications (OR 0.99, 95% CI 0.51-1.92; p = 0.98); life threatening and major bleeding (OR 0.77, 95% CI 0.45-1.33; p = 0.35); minor vascular complications (OR 1.37, 95% CI 0.63-2.99; p = 0.43); minor bleeding (OR 0.94, 95% CI 0.57-1.56; p = 0.82); device failure (OR 0.74, 95% CI 0.49-1.11; p = 0.14); hematoma formation (OR 0.76, 95% CI 0.33-1.75; p = 0.52); dissection, stenosis, occlusion, or pseudoaneurysm (OR 1.08, 95% CI 0.71-1.62; p = 0.73) and short-term mortality (OR 1.01, 95% CI 0.55-1.84; p = 0.98) between both devices were similar. MANTA device has a similar efficacy and safety profile compared to Perclose device.
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Affiliation(s)
| | - Carmelo Venero
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Sundas Younas
- Khyber Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | | | - Ibrar Anjum
- Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Unaiza Ijaz
- Khyber Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sajjad Haider
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Sameer Saleem
- University of Kentucky College of Medicine, Lexington, KY, USA
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2
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Androshchuk V, Chehab O, Prendergast B, Rajani R, Patterson T, Redwood S. Computed tomography derived anatomical predictors of vascular access complications following transfemoral transcatheter aortic valve implantation: A systematic review. Catheter Cardiovasc Interv 2024; 103:169-185. [PMID: 37994240 PMCID: PMC10915898 DOI: 10.1002/ccd.30918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Vascular complications after percutaneous transfemoral transcatheter aortic valve implantation (TAVI) are associated with adverse clinical outcomes and remain a significant challenge. AIMS The purpose of this review is to synthesize the existing evidence regarding the iliofemoral artery features predictive of vascular complications after TAVI on pre-procedural contrast-enhanced multidetector computed tomography (MDCT). METHODS A systematic search was performed in Embase and Medline (Pubmed) databases. Studies of patients undergoing transfemoral TAVI with MDCT were included. Studies with only valve-in-valve TAVI, planned surgical intervention and those using fluoroscopic assessment were excluded. Data on study cohort, procedural characteristics and significant predictors of vascular complications were extracted. RESULTS We identified 23 original studies involving 8697 patients who underwent TAVI between 2006 and 2020. Of all patients, 8514 (97.9%) underwent percutaneous transfemoral-TAVI, of which 8068 (94.8%) had contrast-enhanced MDCT. The incidence of major vascular complications was 6.7 ± 4.1% and minor vascular complications 26.1 ± 7.8%. Significant independent predictors of major and minor complications related to vessel dimensions were common femoral artery depth (>54 mm), sheath-to-iliofemoral artery diameter ratio (>0.91-1.19), sheath-to-femoral artery diameter ratio (>1.03-1.45) and sheath-to-femoral artery area ratio (>1.35). Substantial iliofemoral vessel tortuosity predicted 2-5-fold higher vascular risk. Significant iliofemoral calcification predicted 2-5-fold higher risk. The iliac morphology score was the only hybrid scoring system with predictive value. CONCLUSIONS Independent iliofemoral predictors of access-site complications in TAVI were related to vessel size, depth, calcification and tortuosity. These should be considered when planning transfemoral TAVI and in the design of future risk prediction models.
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Affiliation(s)
- Vitaliy Androshchuk
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
- Department of CardiologySt Thomas’ Hospital, King's College LondonLondonUK
| | - Omar Chehab
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
- Department of CardiologySt Thomas’ Hospital, King's College LondonLondonUK
| | | | - Ronak Rajani
- Department of CardiologySt Thomas’ Hospital, King's College LondonLondonUK
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Tiffany Patterson
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
- Department of CardiologySt Thomas’ Hospital, King's College LondonLondonUK
| | - Simon Redwood
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
- Department of CardiologySt Thomas’ Hospital, King's College LondonLondonUK
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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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Meertens M, Wegner M, Fischnaler C, Wienemann H, Macherey S, Lee S, Kuhn E, Mauri V, Dorweiler B, Baldus S, Adam M, Ahmad W. Surgical Versus Interventional Treatment of Major Access Site Complications During Transfemoral TAVI Procedures at a Large Volume Center. J Endovasc Ther 2023:15266028231204291. [PMID: 37853703 DOI: 10.1177/15266028231204291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE Access-related vascular complications in transfemoral transcatheter aortic valve implantation (TAVI) can be treated endovascularly or surgically. The aim of this study was to evaluate the short- and long-term outcomes of endovascular treatment compared with surgical repair for access-related vascular complications. METHODS This retrospective study was performed from January 1, 2018, to December 31, 2020. All transfemorally treated TAVI patients in whom a surgical or endovascular treatment for an access site complication was needed were included. The primary outcome was the need for any related vascular re-operation. RESULTS In total, 1219 transfemoral TAVI procedures were conducted during the study period. 19 patients suffered an access complication requiring endovascular treatment, while 54 patients required surgical repair. No differences were seen with regard to re-operations (endovascular 15.8% vs surgical 14.8%; p=0.919), wound infections (endovascular 0% vs surgical. 11.1%; p=0.129), and wound healing disorders (endovascular 15.8% vs surgical 29.6%; p=0.237). Patients undergoing endovascular treatment were discharged earlier (endovascular 11.2 vs surgical 14.9 days; p=0.028). After surgical repair, patients received significantly more blood transfusions than endovascularly treated patients (endovascular 1.00 vs surgical 3.1 red blood cell concentrate bags; p<0.001). No differences were found regarding the new onset of walking pain, rest pain, and ischemic ulcers during follow-up. CONCLUSION In this retrospective cohort, endovascular treatment of access-related vascular complications of transfemoral TAVI procedures was safe and feasible. During the hospital stay, endovascularly treated patients received fewer blood transfusions and were discharged faster than surgically treated patients. No differences regarding clinical outcomes and re-intervention rates were seen during the follow-up. CLINICAL IMPACT Given the in this retrospective study demonstrated safety and feasibility of endovascular treatment for major access-related vascular complications, along with the in-hospital benefits and absence of follow-up disadvantages compared to surgical treatment, endovascular treatment should be considered in cases of major access-related vascular complications in transfemoral TAVI patients.
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Affiliation(s)
- Max Meertens
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Moritz Wegner
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Carlos Fischnaler
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Hendrik Wienemann
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sascha Macherey
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Samuel Lee
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Victor Mauri
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Matti Adam
- Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Wael Ahmad
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
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5
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Meertens MM, Tenorio ER, Lemmens CC, Marcondes GB, Lima GBB, Schurink GWH, Mendes BC, Oderich GS, Mees BME. Safety of Percutaneous Femoral Access for Endovascular Aortic Aneurysm Repair Through Previously Surgically Exposed or Repaired Femoral Arteries. J Endovasc Ther 2023; 30:730-738. [PMID: 35514295 PMCID: PMC10503241 DOI: 10.1177/15266028221092980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Percutaneous femoral artery access is being increasingly used in endovascular aortic repair (EVAR). The technique can be challenging in patients with previously surgically exposed or repaired femoral arteries because of excessive scar tissue. However, a successful percutaneous approach may cause less morbidity than a "re-do" open femoral approach. The aim of this study was to assess the impact of prior open surgical femoral exposure on technical success and clinical outcomes of percutaneous approach. METHODS This study retrospectively reviewed the clinical data of patients who underwent percutaneous EVAR between 2010 and 2020 at 2 major aortic centers. Patients were divided into 2 groups (with or without prior open surgical femoral access) for analysis of clinical outcomes. Only punctures with sheaths ≥12Fr were included for analysis. The access and (pre)closure techniques were similar in both institutions. Primary end points were intraoperative technical success, access-related revision, and access complications. A multivariate analysis was performed to identify determinants of conversion to open approach and femoral access complications in intact and re-do groins. RESULTS A total of 632 patients underwent percutaneous (complex) EVAR: 98 had prior open surgical femoral access and 534 patients underwent de novo femoral percutaneous access. A total of 1099 femoral artery punctures were performed: 149 in re-do and 950 in intact groins. The extent of endovascular repair included 159 infrarenal, 82 thoracic, 368 fenestrated/branched, and 23 iliac branch devices. No significant differences were seen in technical success (re-do 93.3% vs intact 95.3%, p=0.311), access-related surgical revision (0.7% vs 0.6%, p=0.950), and access complications (2.7% vs 4.0%, p=0.443). For the whole group, significant predictors for access complications in multivariate analyses were main access site (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.07%-5.35%; p=0.033) and increase of the procedure time per hour (OR 1.65; 95% CI 1.34%-2.04%; p<0.001), while increase in sheath-vessel ratio had a protective effect (OR 0.33; 95% CI 0.127%-0.85%; p=0.021). Surgical conversion was predicted by main access site (OR 2.32; 95% CI 1.28%-4.19%; p=0.007) and calcification of 50% to 75% of the circumference of the access vessel (OR 3.29; 95% CI 1.38%-7.86%; p=0.005). CONCLUSION Within our population prior open surgical femoral artery exposure or repair had no negative impact on the technical success and clinical outcomes of percutaneous (complex) endovascular aortic aneurysm repair.
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Affiliation(s)
- Max M. Meertens
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- European Vascular Center Aachen-Maastricht, Aachen, Germany
| | - Emanuel R. Tenorio
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, TX, USA
| | - Charlotte C. Lemmens
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- European Vascular Center Aachen-Maastricht, Aachen, Germany
| | - Giulianna B. Marcondes
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, TX, USA
| | - Guilherme B. B. Lima
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, TX, USA
| | - Geert Willem H. Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- European Vascular Center Aachen-Maastricht, Aachen, Germany
| | - Bernardo C. Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gustavo S. Oderich
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, TX, USA
| | - Barend M. E. Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- European Vascular Center Aachen-Maastricht, Aachen, Germany
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6
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Eckel CE, Kim WK, Grothusen C, Tiyerili V, Elsässer A, Sötemann D, Schlüter J, Choi YH, Charitos EI, Renker M, Hamm CW, Dohmen G, Möllmann H, Blumenstein J. Comparison of the New-Generation Self-Expanding NAVITOR Transcatheter Heart Valve with Its Predecessor, the PORTICO, in Severe Native Aortic Valve Stenosis. J Clin Med 2023; 12:3999. [PMID: 37373693 DOI: 10.3390/jcm12123999] [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: 04/28/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Third-generation transcatheter heart valves (THVs) are designed to improve outcomes. Data on the new intra-annular self-expanding NAVITOR are scarce. AIMS The aim of this analysis was to compare outcomes between the PORTICO and the NAVITOR systems. METHODS Data from 782 patients with severe native aortic stenosis treated with PORTICO (n = 645) or NAVITOR (n = 137) from 05/2012 to 09/2022 were evaluated. The clinical and hemodynamic outcomes of 276 patients (PORTICO, n = 139; NAVITOR, n = 137) were evaluated according to VARC-3 recommendations. RESULTS Rates of postprocedural more-than-mild paravalvular leakage (PVL) were significantly lower for NAVITOR than for PORTICO (7.2% vs. 1.5%, p = 0.041). In addition, severe bleeding rates (27.3% vs. 13.1%, p = 0.005) and major vascular complications (5.8% vs. 0.7%, p = 0.036) were lower in the NAVITOR group. The mean gradients (7 vs. 8 mmHg, p = 0.121) and calculated aortic valve areas (1.90 cm2 vs. 1.99 cm2, p = 0.235) were comparable. Rates of PPI were similarly high in both groups (15.3 vs. 21.6, p = 0.299). CONCLUSIONS The NAVITOR demonstrated favorable in-hospital procedural outcome data, with lower rates of relevant PVL, major vascular complications, and severe bleeding than its predecessor the PORTICO and preserved favorable hemodynamic outcomes.
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Affiliation(s)
- Clemens Enno Eckel
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Won-Keun Kim
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Christina Grothusen
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiac and Vascular Surgery, University of Kiel, 24098 Kiel, Germany
| | - Vedat Tiyerili
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Dagmar Sötemann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Judith Schlüter
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | | | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Bad Nauheim, Germany
| | - Christian W Hamm
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Bad Nauheim, Germany
- Department of Cardiology, University of Giessen, 35390 Giessen, Germany
| | - Guido Dohmen
- Department of Cardiac Surgery, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Johannes Blumenstein
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
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7
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Kmiec L, Zerdzitzki M, Schmid C, Debl K, Sossalla S, Hilker M, Holzamer A. Evaluation of the MANTA Vascular Closure Device in Transfemoral TAVI. Thorac Cardiovasc Surg 2023; 71:84-93. [PMID: 34176110 DOI: 10.1055/s-0041-1730972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The MANTA vascular closure device (VCD) is a novel collagen plug-based VCD for large bore arteriotomies. The current literature regarding complication rates of this device is quite variable and mostly limited to relatively small case series. METHODS This study is retrospective analysis of the MANTA VCD-related main access site complications according to Valve Academic Research Consortium-2 (VARC-2) criteria during the hospital stay. Particular attention was paid to the detailed analysis of multislice computed tomography with regard to the anatomy of the access vessel and the puncture site itself. RESULTS A total of 524 patients underwent transfemoral transcatheter aortic valve implantation (TF TAVI) including the use of the MANTA device (18F) for percutaneous vascular closure. A group of 22 patients was excluded from the study due to incomplete imaging data. During the study period, we observed 28 major (5.6%) and five minor (1.0%) MANTA device-related vascular complications. There was no patient death related to these adverse events. Female gender, vessel angulation at the puncture site, and at least moderate calcification of the dorsal vessel segment were identified as independent predictors for major complications. CONCLUSIONS The MANTA device is a feasible option for vascular closure of large bore arteriotomies in patients undergoing TF TAVI or other percutaneous transfemoral interventions. Furthermore, we have identified novel predictors for device failure/complications that should be taken into account for selection of the appropriate closure device. To our knowledge, this report is one of the largest case series analyzing the use of the MANTA VCD.
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Affiliation(s)
- Lukasz Kmiec
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Matthaeus Zerdzitzki
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Holzamer
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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8
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Masiero G, Paradies V, Franzone A, Bellini B, De Biase C, Karam N, Sanguineti F, Mamas MA, Eltchaninoff H, Fraccaro C, Castiglioni B, Attisano T, Esposito G, Chieffo A. Sex-Specific Considerations in Degenerative Aortic Stenosis for Female-Tailored Transfemoral Aortic Valve Implantation Management. J Am Heart Assoc 2022; 11:e025944. [PMID: 36172929 DOI: 10.1161/jaha.121.025944] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The impact of sex on pathophysiological processes, clinical presentation, treatment options, as well as outcomes of degenerative aortic stenosis remain poorly understood. Female patients are well represented in transfemoral aortic valve implantation (TAVI) trials and appear to derive favorable outcomes with TAVI. However, higher incidences of major bleeding, vascular complications, and stroke have been reported in women following TAVI. The anatomical characteristics and pathophysiological features of aortic stenosis in women might guide a tailored planning of the percutaneous approach. We highlight whether a sex-based TAVI management strategy might impact on clinical outcomes. This review aimed to evaluate the impact of sex from diagnosis to treatment of degenerative aortic stenosis, discussing the latest evidence on epidemiology, pathophysiology, clinical presentation, therapeutic options, and outcomes. Furthermore, we focused on technical sex-oriented considerations in TAVI including the preprocedural screening, device selection, implantation strategy, and postprocedural management.
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Affiliation(s)
- Giulia Masiero
- Department of Cardiac, Thoracic Vascular Science and Public Health, University of Padova Italy
| | - Valeria Paradies
- Department of Cardiology Maasstad Hospital Rotterdam The Netherlands
| | - Anna Franzone
- Department of Advanced Biomedical Sciences Federico II University of Naples Italy
| | - Barbara Bellini
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel Clinique Pasteur Toulouse France
| | - Nicole Karam
- Cardiology Department European Hospital Georges Pompidou Paris France
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group School of Medicine, Keele University Stoke-on-Trent United Kingdom.,Department of Cardiology Royal Stoke University Hospital Stoke-on-Trent United Kingdom.,Department of Medicine Thomas Jefferson University Philadelphia PA
| | | | - Chiara Fraccaro
- Department of Cardiac, Thoracic Vascular Science and Public Health, University of Padova Italy
| | | | - Tiziana Attisano
- Division of Interventional Cardiology Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi Salerno Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences Federico II University of Naples Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
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9
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Blumenstein J, Eckel C, Husser O, Kim WK, Renker M, Choi YH, Hamm CW, Al-Terki H, Sötemann D, Körbi L, Tiyerili V, Grothusen C, Gaede L, Dohmen G, Möllmann H. Multi-Center Comparison of Two Self-Expanding Transcatheter Heart Valves: A Propensity Matched Analysis. J Clin Med 2022; 11:jcm11144228. [PMID: 35887990 PMCID: PMC9318122 DOI: 10.3390/jcm11144228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 02/01/2023] Open
Abstract
Background: During the last years, several transcatheter aortic heart valves entered the clinical market and are commercially available. The prostheses differ regarding several technical and functional aspects. However, little is known regarding head-to-head comparative data of the ACURATE neo and the PORTICO valve prostheses. Objectives: The aim of this study was to compare two self-expanding transcatheter aortic heart valves (THV), the ACURATE neo and the PORTICO, with regard to in-hospital and 30-day outcomes, as well as early device failures. Methods: A total of 1591 consecutive patients with severe native aortic valve stenosis from two centers were included in the analyses and matched by 1:1 nearest neighbor matching to identify one patient treated with PORTICO (n = 344) for each patient treated with ACURATE neo (n = 344). Results: In-hospital complications were comparable between both valves, including any kind of stroke (ACURATE neo = 3.5% vs. PORTICO = 3.8%; p = 1.0), major vascular complications (ACURATE neo = 4.5% vs. PORTICO = 5.4%; p = 0.99) or life-threatening bleeding (ACURATE neo = 1% vs. PORTICO = 2%; p = 0.68). The rate of device failure defined by the VARC-2 criteria were comparable, including elevated gradients and moderate-to-severe paravalvular leakage (ACURATE neo = 7.3% vs. PORTICO = 7.6%; p = 1.0). However, the need for permanent pacemaker implantation (PPI) was significantly more frequent after the use of PORTICO THV (9.5% vs. 18.7%; p = 0.002). Conclusions: In this two-center case-matched comparison, short-term clinical and hemodynamic outcomes showed comparable results between PORTICO and ACURATE neo prostheses. However, PORTICO was associated with a significant higher incidence of PPI.
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Affiliation(s)
- Johannes Blumenstein
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
- Medical School, Carl von Ossietzky University, 26111 Oldenburg, Germany
- Correspondence: ; Tel.: +49-(0)231-1843-35100; Fax: +49-(0)231-35900
| | - Clemens Eckel
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
- Medical School, Carl von Ossietzky University, 26111 Oldenburg, Germany
| | - Oliver Husser
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany; (W.-K.K.); (M.R.); (C.W.H.)
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany;
- Department of Cardiology, Justus-Liebig University of Giessen, 35390 Giessen, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany; (W.-K.K.); (M.R.); (C.W.H.)
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany;
| | - Christian W. Hamm
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany; (W.-K.K.); (M.R.); (C.W.H.)
- Department of Cardiology, Justus-Liebig University of Giessen, 35390 Giessen, Germany
| | - Hani Al-Terki
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Dagmar Sötemann
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Leon Körbi
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Vedat Tiyerili
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Christina Grothusen
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
| | - Luise Gaede
- Department of Medicine 2-Cardiology and Angiology, Friedrich-Alexander University, 91054 Erlangen, Germany;
| | - Guido Dohmen
- Department of Cardiothoracic Surgery, St.-Johannes-Hospital, 11137 Dortmund, Germany;
| | - Helge Möllmann
- Department of Internal Medicine I, St.-Johannes-Hospital, 44137 Dortmund, Germany; (C.E.); (O.H.); (H.A.-T.); (D.S.); (L.K.); (V.T.); (C.G.); (H.M.)
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10
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Meertens MM, van Herwaarden JA, de Vries JPPM, Verhagen HJM, van der Laan MJ, Reijnen MMPJ, Schurink GWH, Mees BME. Multicenter Experience of Upper Extremity Access in Complex Endovascular Aortic Aneurysm Repair. J Vasc Surg 2022; 76:1150-1159. [PMID: 35709857 DOI: 10.1016/j.jvs.2022.04.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/10/2022] [Accepted: 04/26/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Upper extremity access (UEA) for antegrade cannulation of aortic side branches is a relevant part of endovascular treatment of complex aortic aneurysms and can be achieved using several techniques, sites and sides. The purpose of this study was to evaluate different UEA strategies in a multicenter registry of complex endovascular aortic aneurysm repair (EVAR). METHODS In six aortic centers in the Netherlands, all endovascular aortic procedures from 2006 to 2019 were retrospectively reviewed. Patients who received upper extremity access during complex EVAR were included. Primary outcome was a composite endpoint of any access complication, excluding minor hematomas. Secondary outcomes were access characteristics, access complications considered individually, access reinterventions and incidence of ischemic cerebrovascular events. RESULTS 417 patients underwent 437 UEA for 303 fenestrated/branched EVARs, and 114 chimney EVARs. Twenty patients had bilateral, 295 left-sided, and 102 right-sided UEA. 413 approaches were performed surgically and 24 percutaneously. Distal brachial access was used in 89 cases, medial brachial in 149, proximal brachial in 140 and axillary access in 59 cases. No significant differences regarding the composite endpoint of access complications were seen (DBA 11.3% vs. MBA 6.7% vs. PBA 13.6% vs. AA 10.2%; p=.29). Postoperative neuropathy occurred most after proximal brachial access (DBA 1.1% vs. MBA 1.3% vs. PBA 9.3 % vs. AA 5.1%; p=.003). There were no differences in cerebrovascular complications between access sides (right 5.9% vs. left 4.1% vs. bilateral 5%; p=.75). Significantly more overall access complications were seen after a percutaneous approach (29.2% vs. 6.8%; p=.002). In multivariate analysis the risk for access complications after open approach was decreased by male gender (OR 0.27; CI 95% 0.10 - 0.72; p= .009), while an increase in age per year (OR 1.08; CI 95% 1.004 - 1.179; p=.039) and diabetes mellitus type 2 (OR 3.70; CI 95% 1.20 - 11.41; p= .023) increased the risk. CONCLUSION Between the four access localizations, there were no differences in overall access complications. Female gender, diabetes mellitus type 2 and ageing increased the risk for access complications after surgical approach. Furthermore, a percutaneous upper extremity access resulted in higher complication rates than a surgical approach.
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Affiliation(s)
- M M Meertens
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department III of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - J A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J P P M de Vries
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - H J M Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M J van der Laan
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - M M P J Reijnen
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, and Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - G W H Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; European Vascular Center Aachen-Maastricht, the Netherlands/ Germany
| | - B M E Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; European Vascular Center Aachen-Maastricht, the Netherlands/ Germany.
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11
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Junquera L, Alperi A, Panagides V, Mesnier J, Paradis JM, DeLarochellière R, Mohammadi S, Dumont E, Kalavrouziotis D, Rodés-Cabau J. Late Access Site Complications Following Transfemoral Aortic Valve Implantation. Am J Cardiol 2022; 169:86-92. [PMID: 35105462 DOI: 10.1016/j.amjcard.2021.12.054] [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: 10/10/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
Few data exist on late vascular complications (VCs) after transfemoral (TF) transcatheter aortic valve implantation (TAVI). The objective of this study was to evaluate the incidence and predictors of late access site VC after TF TAVI. A total of 128 patients (mean age: 80 ± 8 years, women: 52%) who underwent TF TAVI without major VC were included. A femoral US-Doppler evaluation was performed in all patients at a median of 5 (3 to 15) months after the procedure, and 76 patients (59.4%) also had a preprocedural ultrasound (US)-Doppler examination. The impact of baseline and procedural factors (including the use of simple 2 Proglides or complex additional Proglide or Angioseal device on top of the 2 Proglide technique, hemostasis techniques, and the use of balloon dilation for optimizing femoral hemostasis) were evaluated. The follow-up US-Doppler evaluation detected 2 asymptomatic VCs (1.6%), and 5 (3.9%) patients exhibited significant femoral stenosis (peak systolic velocity [PSV] ≥300 cm/s). Female gender (p <0.001) and smaller femoral diameter (p = 0.045) were associated with higher femoral PSV values. In those patients who underwent a pre-TAVI femoral US-Doppler, the median PSV values after TAVI were higher compared with those obtained pre-TAVI (p <0.001), but similar results were found for the contralateral femoral arteries. A complex hemostasis technique or the use of balloon optimization at the puncture site was not associated with any increase in PSV values. In conclusion, percutaneous femoral hemostasis after TAVI was associated with a low rate of late VC. The results were similar irrespective of the hemostasis technique and the use of balloon dilation at the puncture site, but women and a smaller femoral size were associated with increased PSV values. Further studies are needed to determine the optimal femoral hemostasis technique in TAVI procedures.
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12
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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:jcm11082104. [PMID: 35456197 PMCID: PMC9028438 DOI: 10.3390/jcm11082104] [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: 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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13
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Sliman H, Eitan A, Shiran A, Zafrir B, Jaffe R. Transbrachial Secondary Vascular Access in Transcatheter Aortic Valve Replacement Procedures: A Single-Centre Retrospective Analysis. Heart Lung Circ 2022; 31:1023-1028. [PMID: 35277348 DOI: 10.1016/j.hlc.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/30/2021] [Accepted: 01/27/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Transfemoral transcatheter aortic valve replacement (TAVR) procedures require secondary vascular access for inserting accessory catheters and performing percutaneous repair of femoral artery injury. Use of the transbrachial approach for secondary vascular access in TAVR procedures has not been reported. METHODS This study identified 48 patients at the current institution who had undergone transfemoral TAVR utilising transbrachial secondary vascular access. Efficacy and safety of this strategy for achieving a successful totally percutaneous procedure were examined. Study endpoints were occurrence of vascular complications and bleeding related to transbrachial access, as well as periprocedural and 1-year mortality. RESULTS Mean patient age was 80±7 years and Society of Thoracic Surgeons Predicted Risk of Mortality score was 10.6±3.1. Sizes of sheaths inserted into the brachial artery were 6 Fr (85%), 8 Fr (2%), and 9 Fr (13%). Transbrachial access was used for delivering stent grafts to the femoral artery in 13% of the patients, inflation of an occlusive balloon within the iliac artery in 10%, and treatment of iatrogenic femoral artery stenosis in 2%. Successful valve replacement was achieved in all cases. Brachial sheaths were removed by manual compression following administration of protamine sulfate. There were no major access site complications or VARC-3 type ≥2 bleeding related to the brachial vascular access. Brachial artery occlusion occurred in two patients (4%) who underwent surgical vascular repair. Two (2) additional patients developed mild arm ischaemia, which was treated conservatively. Periprocedural mortality was 0% and early mortality was 8%. CONCLUSIONS Transbrachial secondary access in TAVR procedures was feasible and enabled percutaneous vascular repair in cases of femoral artery injury.
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Affiliation(s)
- Hussein Sliman
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Avinoam Shiran
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Barak Zafrir
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Ronen Jaffe
- Department of Cardiology, Carmel Medical Center, Haifa, Israel.
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14
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Lux A, Müllenberg L, Veenstra LF, Dohmen W, Kats S, Maesen B, van’t Hof AW. Iliofemoral tortuosity increases the risk of access site-related complications after aortic valve implantation and plug-based access site closure. CJC Open 2022; 4:609-616. [PMID: 35865026 PMCID: PMC9294987 DOI: 10.1016/j.cjco.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Access-site-related complications are often related to high-risk anatomy and technical pitfalls and impair the outcomes of transfemoral aortic valve implantations (TAVIs). Calcification and tortuosity are widely recognized risk factors, and their impact on procedural planning is left to the implanting experts’ discretion. To facilitate decision-making, we introduced a quantitative measure for iliofemoral tortuosity and assessed its predictive value for access-site-related vascular and bleeding complications. Methods We performed a single-centre prospective cohort study of consecutive, percutaneous transfemoral TAVI performed between April 2019 and March 2020. Medical history and all-cause mortality were extracted from the electronic patient files. Arterial anatomy and calcifications were evaluated using 3mensio Structural Heart software. The primary outcome was access-site-related vascular or bleeding complications. Results In this elderly, intermediate-risk population, we registered the primary outcome in 43 patients (39%), and major access-site complications in 10 patients (9.2%). Complete hemostasis was achieved in 77 patients (70.6%), by the application of the MANTA plug alone. In the group with access-site-related adverse events, compared with the group without, the tortuosity index was higher median (26% interquartile range [IQR 18%-33%] vs median 19% [IQR 13%-29%], respectively; P = 0.012), as was maximal angulation median (50° [IQR 40°-59°] vs median 43° [IQR 36°-51°], respectively; P = 0.026) were higher. Both variables had a significant effect on our primary outcome, with odds ratios (OR) of 3.1 (tortuosity, P = 0.005) and 2.6 (angulation, P = 0.020). The degree of angulation was a predictor of major complications too (odds ratio 7 [1.4-34.8]; P = 0.017). Conclusions Steeper angles and greater arterial elongation increase the risk of vascular and bleeding complications after femoral TAVI with the utilization of a plug-based closure device.
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Affiliation(s)
- Arpad Lux
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht University, Maastricht, The Netherlands
- Corresponding author: Dr Arpad Lux, Cardiology Secretariat, PO Box 5800 | 6202 AZ Maastricht, The Netherlands. Tel.: +31(0)43-3875087.
| | - Lisa Müllenberg
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Leo F. Veenstra
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wim Dohmen
- Business Information Management, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Suzanne Kats
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bart Maesen
- Cardiovascular Research Institute Maastricht University, Maastricht, The Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Arnoud W.J. van’t Hof
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Centrum, Heerlen, The Netherlands
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15
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Ruge H, Burri M, Erlebach M, Lange R. Propensity matched analysis of vascular complications using integrated or expandable sheaths for TAVR. Catheter Cardiovasc Interv 2022; 99:1611-1618. [DOI: 10.1002/ccd.30088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/20/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Hendrik Ruge
- Department of Cardiovascular Surgery INSURE (Institute for Translational Cardiac Surgery), German Heart Center, TUM Munich Germany
- Department of Cardiovascular Surgery German Heart Center Munich, TUM Munich Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery INSURE (Institute for Translational Cardiac Surgery), German Heart Center, TUM Munich Germany
- Department of Cardiovascular Surgery German Heart Center Munich, TUM Munich Germany
| | - Magdalena Erlebach
- Department of Cardiovascular Surgery INSURE (Institute for Translational Cardiac Surgery), German Heart Center, TUM Munich Germany
- Department of Cardiovascular Surgery German Heart Center Munich, TUM Munich Germany
| | - Ruediger Lange
- Department of Cardiovascular Surgery INSURE (Institute for Translational Cardiac Surgery), German Heart Center, TUM Munich Germany
- Department of Cardiovascular Surgery German Heart Center Munich, TUM Munich Germany
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16
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Heitzinger G, Brunner C, Koschatko S, Dannenberg V, Mascherbauer K, Halavina K, Doná C, Koschutnik M, Spinka G, Nitsche C, Mach M, Andreas M, Wolf F, Loewe C, Neumayer C, Gschwandtner M, Willfort-Ehringer A, Winter MP, Lang IM, Bartko PE, Hengstenberg C, Goliasch G. A Real World 10-Year Experience With Vascular Closure Devices and Large-Bore Access in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2022; 8:791693. [PMID: 35127860 PMCID: PMC8814307 DOI: 10.3389/fcvm.2021.791693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/17/2021] [Indexed: 12/19/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has established itself as a safe and efficient treatment option in patients with severe aortic valve stenosis, regardless of the underlying surgical risk. Widespread adoption of transfemoral procedures led to more patients than ever being eligible for TAVR. This increase in procedural volumes has also stimulated the use of vascular closure devices (VCDs) for improved access site management. In a single-center examination, we investigated 871 patients that underwent transfemoral TAVR from 2010 to 2020 and assessed vascular complications according to the Valve Academic Research Consortium (VARC) III recommendations. Patients were grouped by the VCD and both, vascular closure success and need for intervention were analyzed. In case of a vascular complication, the type of intervention was investigated for all VCDs. The Proglide VCD was the most frequently used device (n = 670), followed by the Prostar device (n = 112). Patients were old (median age 83 years) and patients suffered from high comorbidity burden (60% coronary artery disease, 30% type II diabetes, 40% atrial fibrillation). The overall rate of major complications amounted to 4.6%, it was highest in the Prostar group (9.6%) and lowest in the Manta VCD group (1.1% p = 0.019). The most frequent vascular complications were bleeding and hematoma (n = 110, 13%). In case a complication occurred, 72% of patients did not need any further intervention other than manual compression or pressure bandages. The rate of surgical intervention after complication was highest in the Prostar group (n = 15, 29%, p = 0.001). Temporal trends in VCD usage highlight the rapid adoption of the Proglide system after introduction at our institution. In recent years VCD alternatives, utilizing other closure techniques, such as the Manta device emerged and increased vascular access site management options. This 10-year single-center experience demonstrates high success rates for all VCDs. Despite successful closure, a significant number of patients does experience minor vascular complications, in particular bleeding and hematoma. However, most complications do not require surgical or endovascular intervention. Temporal trends display a marked increase in TAVR procedures and highlight the need for more refined vascular access management strategies.
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Affiliation(s)
- Gregor Heitzinger
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Brunner
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Sophia Koschatko
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Varius Dannenberg
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Katharina Mascherbauer
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Kseniya Halavina
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Carolina Doná
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Matthias Koschutnik
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg Spinka
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Markus Mach
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Florian Wolf
- Department of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Department of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Neumayer
- Department of Vascular Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Gschwandtner
- Division for Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andrea Willfort-Ehringer
- Division for Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Max-Paul Winter
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Irene M. Lang
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Philipp E. Bartko
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Division for Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- *Correspondence: Georg Goliasch
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17
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Costa G, Valvo R, Picci A, Criscione E, Reddavid C, Motta S, Strazzieri O, Deste W, Giuffrida A, Garretto V, Cannizzaro M, Inserra C, Veroux P, Giaquinta A, Sgroi C, Tamburino C, Barbanti M. An upfront combined strategy for endovascular haemostasis in transfemoral transcatheter aortic valve implantation. EUROINTERVENTION 2021; 17:728-735. [PMID: 33589411 PMCID: PMC9724957 DOI: 10.4244/eij-d-20-01125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Vascular complications still represent an important issue after transcatheter aortic valve implantation (TAVI). AIMS The aim of this study was to evaluate the effectiveness of upfront use of an adjunctive Angio-Seal (AS) plug-based system on top of suture-based devices (SBDs) for endovascular haemostasis after transfemoral (TF) TAVI. METHODS From January 2019 to April 2020, 332 consecutive patients with preprocedural computed tomography angiography (CTA) assessment underwent fully percutaneous TF-TAVI. The primary outcomes were 30-day major vascular complications and major or life-threatening (LT) bleeding due to endovascular closure system failure. A total of 246 TF-TAVI patients (123 pairs), undergoing either isolated SBD or SBD+AS, were matched using the propensity-score method. RESULTS At 30 days, patients receiving SBD+AS had lower rates of major/LT bleeding (1.6% vs 8.9%, odds ratio [OR] 0.17, 95% confidence interval [CI]: 0.04-0.78; p<0.01) and major vascular complications (1.6% vs 8.9%, OR 0.17, 95% CI: 0.04-0.78; p<0.01). In addition, the use of SBD+AS was associated with a significant cost saving related to the vascular event (mean difference -315.3 € per patient, 95% CI: -566.4 € to -64.1 €; p=0.01), and a higher probability of next-day discharge (NDD) after TAVI (30.9% vs 16.3%, OR 2.30, 95% CI: 1.25-4.25; p<0.01). No difference in all-cause 30-day mortality was observed (3.3% vs 1.6% for SBD and SBD+AS groups, respectively, OR 0.49, 95% CI: 0.09-2.74; p=0.41). CONCLUSIONS An upfront combined strategy with an additional AS plug-based device on top of SBDs was shown to reduce major vascular complications and major/LT bleeding due to closure system failure after TF-TAVI. This approach was associated with a cost saving and with a higher probability of NDD compared to the use of isolated SBD. Visual summary. Effectiveness of the upfront combined strategy for endovascular haemostasis in transfemoral transcatheter aortic valve implantation using Angio-Seal on top of a suture-based device (SBD) versus the isolated use of SBD. LT: life-threatening; TF-TAVI: transfemoral transcatheter aortic valve implantation.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Andrea Picci
- Division of Cardiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Enrico Criscione
- Division of Cardiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Claudia Reddavid
- Division of Cardiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Silvia Motta
- Division of Cardiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Orazio Strazzieri
- Division of Cardiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Wanda Deste
- Division of Cardiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Angelo Giuffrida
- Division of Cardiac Surgery, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Valeria Garretto
- Division of Radiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Maria Cannizzaro
- Division of Radiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Cristina Inserra
- Division of Radiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Division of Vascular Surgery, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Alessia Giaquinta
- Division of Vascular Surgery, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Carmelo Sgroi
- Division of Cardiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Policlinico-San Marco Hospital, C.A.S.T., University of Catania, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
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Musumeci G, Annibali G. Access site vascular complications in TAVR: Is this the right time? Catheter Cardiovasc Interv 2021; 97:333-334. [PMID: 33587801 DOI: 10.1002/ccd.29482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe Musumeci
- Department of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
| | - Gianmarco Annibali
- Department of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
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Burri M, Ruge H, Erlebach M, Lange R. Surgical Cutdown Avoids Vascular Complications in Transcatheter Aortic Valve Replacement in Calcified and Small Femoral Arteries. Thorac Cardiovasc Surg 2021; 70:199-204. [PMID: 33761568 DOI: 10.1055/s-0041-1725202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Third-generation transcatheter heart valves (THV) are predominantly implanted through a percutaneous, transfemoral access. To reduce vascular complications, we selectively performed surgical vascular access (cutdown) in patients with particular calcified or small femoral arteries. We aim to review our experience with this approach. METHODS All patients who underwent transfemoral transcatheter aortic valve replacement (TAVR) with a third-generation THV at our institution between March 2014 and April 2019 were included in the study. All available computerized tomography studies were reassessed for access vessel diameter and visual graduation of calcifications. Vascular complications are reported according to Valve Academic Research Consortium-2 criteria. RESULTS A total of 944 patients were included. Among them, 879 patients underwent a percutaneous access and 65 patients underwent surgical cutdown. Also, 459 Evolut R/PRO and 420 Sapien 3/ultra were implanted percutaneously and 40 Evolut R/PRO and 25 Sapien 3 were implanted with a surgical cutdown. Patients with surgical cutdown were older (80.0 ± 7.5 vs. 83.8 ± 7.5 years, p < 0.001), had smaller femoral arteries (8.0 ± 1.6 vs. 7.6 ± 1.6 mm, p = 0.034) and more severe vessel calcifications (17.5 vs. 1.0%, p < 0.001). Procedure time was similar for cutdown and percutaneous access (64.0 vs. 64.5 minutes, p = 0.879). With percutaneous access, 80 major vascular complications (10%) occurred, whereas with surgical cutdown, no major vascular complications occurred (p < 0.005). No wound infection occurred after surgical cutdown. The mean length of stay was 8 days in both groups. CONCLUSION Surgical cutdown for vascular access avoids vascular complications in patients with small or severely calcified femoral arteries.
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Affiliation(s)
- Melchior Burri
- Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany
| | - Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich at the Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research)-partner Site Munich Heart Alliance, Munich, Germany
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20
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Ruge H, Burri M, Erlebach M, Lange R. Access site related vascular complications with third generation transcatheter heart valve systems. Catheter Cardiovasc Interv 2020; 97:325-332. [PMID: 32588968 DOI: 10.1002/ccd.29095] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study examines the impact of anatomical and procedural factors on Valve Academic Research Consortium-2-defined vascular complications at the femoral access site in transcatheter aortic valve replacement (TAVR) with third generation transcatheter heart valve (THV)-systems. BACKGROUND Randomized clinical trials reported on vascular complications with current THV-systems. However, clinical presentation and consequences of these events are not well studied. METHODS All patients who underwent a transfemoral TAVR using an Edwards Sapien3®/Sapien3ultra® or a Medtronic Evolut-R®/Evolut-PRO® have been identified from our institutional database. Only procedures utilizing the PerClose-ProGlide® vascular closure device were included. Risk factors for vascular complications were analyzed with a logistic regression model. Preoperative and procedural data were collected. The postoperative course of patients with and without vascular complications was compared. RESULTS A total of 878 patients met the inclusion criteria. Of these, 152 patients (17.3%) had an access-site related vascular complication (87 major complications, 9.9%). Sheath-to-femoral-artery-ratio (SFAR) (OR per 0.1 increase = 1.35, p < .001) and more than 2 vessel entries with large bore sheaths (OR = 1.76, p = .029) were independent risk factors for vascular complications. Female gender (OR = 1.44, p = .07) and two vessel entries with large bore sheaths (OR = 1.2, p = .53) increased the risk, although no statistical significance was shown. Age (OR = 1.07, p = .62), body mass index (OR = 1.1 per 5 points, p = .32) and vessel wall calcification at puncture site (OR = 0.93, p = .7) had no influence on vascular complications. Patients with vascular complications had a higher need for blood transfusion (p < .001) and a higher in-hospital mortality (2.6 vs. 0.4%, p = .019). CONCLUSIONS Procedural risk assessment should include SFAR calculation and consider the need for large bore sheath exchange. This might reduce the vascular trauma, lower vascular complication rates and improve the clinical outcome after TAVR.
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Affiliation(s)
- Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Center, TUM, INSURE (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, TUM, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center, TUM, INSURE (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, TUM, Munich, Germany
| | - Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Center, TUM, INSURE (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, TUM, Munich, Germany
| | - Ruediger Lange
- Department of Cardiovascular Surgery, German Heart Center, TUM, INSURE (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, TUM, Munich, Germany
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21
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Kinnel M, Faroux L, Villecourt A, Tassan-Mangina S, Heroguelle V, Nazeyrollas P, Poncet A, Ruggieri VG, Metz D. Abdominal aorta tortuosity on computed tomography identifies patients at risk of complications during transfemoral transcatheter aortic valve replacement. Arch Cardiovasc Dis 2020; 113:159-167. [DOI: 10.1016/j.acvd.2019.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/02/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
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22
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Goel R, Power D, Tchetche D, Chandiramani R, Guedeney P, Claessen BE, Sartori S, Cao D, Meneveau N, Tron C, Dumonteil N, Widder JD, Hengstenberg C, Ferrari M, Violini R, Stella PR, Jeger R, Anthopoulos P, Deliargyris EN, Mehran R, Dangas GD. Impact of diabetes mellitus on short term vascular complications after TAVR: Results from the BRAVO-3 randomized trial. Int J Cardiol 2019; 297:22-29. [DOI: 10.1016/j.ijcard.2019.09.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/21/2019] [Accepted: 09/20/2019] [Indexed: 12/17/2022]
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23
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Power D, Schäfer U, Guedeney P, Claessen BE, Sartori S, Sorrentino S, Lefèvre T, Kupatt C, Tchetche D, Dumonteil N, Webb JG, Colombo A, Windecker S, Ten Berg JM, Hildick-Smith D, Boekstegers P, Linke A, Tron C, Van Belle E, Asgar AW, Jeger R, Sardella G, Hink U, Husser O, Grube E, Lechthaler I, Wijngaard P, Anthopoulos P, Deliargyris EN, Bernstein D, Hengstenberg C, Mehran R, Dangas GD. Impact of percutaneous closure device type on vascular and bleeding complications after TAVR: A post hoc analysis from the BRAVO-3 randomized trial. Catheter Cardiovasc Interv 2019; 93:1374-1381. [PMID: 31116908 DOI: 10.1002/ccd.28295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/04/2019] [Accepted: 04/06/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVE Prostar XL (PS) and ProGlide (PG) are common vascular closure devices (VCD) used in TAVR via transfemoral vascular approach. The impact of these VCD on vascular and bleeding complications remains unclear. METHODS The BRAVO-3 trial randomized 802 patients undergoing transfemoral TAVR. We stratified patients according to type of VCD used and examined the 30-day incidence of major or minor vascular complications, major bleeding (BARC ≥3b), AKI and major adverse cardiac and cerebrovascular events (MACCE; death, myocardial infarction or stroke). RESULTS A total of 746 (93%) patients were treated with either PS (n = 352, 47%) or PG (n = 394, 53%) VCD, without significant differences in successful deployment rate (PS 322 [91.2%] vs. PG 373 [94.2%] respectively, p = .20). PG was associated with a significantly lower incidence of major or minor vascular complications, compared to PS (adjusted OR: 0.54; 95% CI: 0.37-0.80; p < .01). Rates of acute kidney injury were also lower with the PG device. There was no significant difference between bleeding, MACCE, and death. CONCLUSIONS Compared to PS, the PG VCD was associated with a lower rate of major or minor vascular complications and lower rates of AKI after transfemoral TAVR.
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Affiliation(s)
- David Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Ulrich Schäfer
- Division of Cardiology, University Heart Center, Hamburg, Germany
| | - Paul Guedeney
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Sabato Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - Thierry Lefèvre
- Department of Cardiology, Hôpital Privé Jacques Cartier, Massy, France
| | | | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur Toulouse, Toulouse, France
| | | | - John G Webb
- Department of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
| | | | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - David Hildick-Smith
- Department of Interventional Cardiology, Sussex Cardiac Center, Brighton, UK
| | | | | | - Christophe Tron
- Department of Cardiology, Rouen University Hospital, Rouen, France
| | - Eric Van Belle
- Department of Cardiology and INSERM UMR 1011, CHU Lille, Lille, France
| | - Anita W Asgar
- Institute de Cardiologie de Montréal, Montreal, Quebec, Canada
| | - Raban Jeger
- Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Ulrich Hink
- Department of Cardiology, Universitätsmedizin Mainz, Mainz, Germany
| | | | | | | | | | | | | | - Debra Bernstein
- Science and Strategy Consulting Group, Basking Ridge, New Jersey
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York City, New York
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Sedaghat A, Hansen KL, Schahab N, May MC, Weber M, Stundl A, Shamekhi J, Schaefer C, Nickenig G, Sinning JM, Lönn L, Søndergaard L, Werner N, De Backer O. Long-term follow-up after stent graft placement for access-site and access-related vascular injury during TAVI - The Bonn-Copenhagen experience. Int J Cardiol 2018; 281:42-46. [PMID: 30711261 DOI: 10.1016/j.ijcard.2018.12.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/23/2018] [Accepted: 12/18/2018] [Indexed: 11/29/2022]
Abstract
AIMS Stent graft placement is a safe and effective treatment option for vascular complications in the context of transcatheter aortic valve implantation (TAVI). This study aimed to provide long-term angiological follow-up of stent grafts used for this indication. METHODS AND RESULTS Seventy-one patients (64.8% female, log EuroScore 14.7 ± 6.8%) who had undergone TAVI between March 2010 and October 2015 with implantation of a Viabahn or Fluency stent graft to treat access-site or access-related vascular injury (ASARVI) were analyzed. Implantations were mostly due to access-site bleeding complications (83.1%) in the common femoral artery (97.1%). Follow-up was performed with duplex sonography in all patients after a median of 3.9 years after TAVI (interquartile range [IQR]: 895-1749 days). Ultrasound revealed tri- or biphasic flow patterns in 16.9% and 77.6%, respectively. Stent graft patency was 100% without signs of stent graft stenosis (mean peak velocity ratio 1.0 ± 0.2). Pseudo-aneurysms or endoleaks were diagnosed in 5.6% of patients. Additional fluoroscopic and/or computed tomography (CT)-imaging was available in 36.6% of patients and did not reveal any stent fracture. CONCLUSION Self-expanding stent grafts provide excellent long-term function with few complications when implanted in the context of TAVI-related ASARVI.
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Affiliation(s)
- Alexander Sedaghat
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | | | - Nadjib Schahab
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Maria Cesarina May
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Marcel Weber
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Anja Stundl
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Jasmin Shamekhi
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Christian Schaefer
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Georg Nickenig
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Jan-Malte Sinning
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | - Lars Lönn
- Cardiovascular Radiology, Faculty of Health Sciences, Rigshospitalet, Copenhagen, Copenhagen, Denmark
| | | | - Nikos Werner
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany.
| | - Ole De Backer
- Heart Center - Rigshospitalet Copenhagen, Copenhagen, Denmark
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25
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Hoffmann P, Al-Ani A, von Lueder T, Skoe ØW, Tran TT, Opdahl A. Late Pseudoaneurysm After Access Site Closure with Manta in Transfemoral Aortic Valve Implantation. EJVES Short Rep 2018; 42:34-36. [PMID: 30931405 PMCID: PMC6424680 DOI: 10.1016/j.ejvssr.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/04/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction Access site vascular complications in transfemoral transcatheter aortic valve implantation (TF-TAVI) are still a major concern. Recently, a novel collagen plug based closure device (Manta) was introduced. The results from the first reports on Manta are very promising, but not much is known about the long-term patency. Report A case of late pseudoaneurysm after access site arterial closure with Manta in TF-TAVI is described. The patient presented five weeks after left sided TF-TAVI with pain and claudication like symptoms in the left leg. CT angiography revealed a pseudoaneurysm at the puncture site. The patient was successfully treated by vascular surgery. Discussion The results from recent peri-operative reports on the Manta vascular closure device (VCD) are promising, but not much is known about the long-term patency. In the present report a patient is described who developed a pseudoaneurysm several weeks after access site closure with Manta. To the authors’ knowledge, no such late access site complications after use of the Manta VCD have been reported previously. Results from peri-operative reports on the Manta vascular closure device are promising. Not much is known about long-term patency. The present report describes a patient who developed a pseudoaneurysm several weeks after access site closure with Manta. No such late access site complications after Manta have been reported previously.
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Affiliation(s)
- Pavel Hoffmann
- Department of Cardiology, Section for Interventional Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Ahmed Al-Ani
- Department of Cardiology, Section for Interventional Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Thomas von Lueder
- Department of Cardiology B, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Øyvind W Skoe
- Department of Vascular Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Thien T Tran
- Department of Interventional Radiology, Akershus University Hospital, Lørenskog, Norway
| | - Anders Opdahl
- Department of Cardiology, Section for Interventional Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
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Furukawa NW, Jumalon FM, Friedman DB, Kelly LR. Concurrent mechanical haemolytic anaemia and heparin-induced thrombocytopenia following transcatheter aortic valve replacement. BMJ Case Rep 2018; 2018:bcr-2017-224069. [PMID: 30344141 PMCID: PMC6202965 DOI: 10.1136/bcr-2017-224069] [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] [Indexed: 11/04/2022] Open
Abstract
A 78-year-old man with a history of severe aortic stenosis presented with confusion, irregular behaviour and dyspnoea 8 days following transcatheter aortic valve replacement. His exam was consistent with a heart failure exacerbation and he had elevated aminotransferases, bilirubin and prothrombin time suggestive of shock liver. A CT head scan demonstrated a subacute large left temporoparietal infarction. His aminotransferase and prothrombin time levels normalised with diuresis, but his indirect bilirubin remained elevated and he developed anaemia and thrombocytopenia consistent with a haemolytic anaemia. A transthoracic echocardiogram demonstrated a paravalvular leak. His thrombocytopenia continued to worsen prompting testing for antibodies against heparin-PF4 complexes which was positive. A serotonin release assay later returned positive, confirming the diagnosis of heparin-induced thrombocytopenia. This case illustrates that the presence of haemolytic anaemia does not necessarily exclude other causes of thrombocytopenia that may occur concurrently.
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Affiliation(s)
- Nathan W Furukawa
- Adult Inpatient Medical Services, Presbyterian Hospital, Albuquerque, New Mexico, USA
| | - Fernando M Jumalon
- Adult Inpatient Medical Services, Presbyterian Hospital, Albuquerque, New Mexico, USA
| | - Daniel B Friedman
- Presbyterian Heart Group, Presbyterian Hospital, Albuquerque, New Mexico, USA
| | - Linda R Kelly
- Department of Pharmacy, Presbyterian Hospital, Albuquerque, New Mexico, USA
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27
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Hoffmann P, Al-Ani A, von Lueder T, Hoffmann J, Majak P, Hagen O, Loose H, Kløw NE, Opdahl A. Access site complications after transfemoral aortic valve implantation - a comparison of Manta and ProGlide. CVIR Endovasc 2018; 1:20. [PMID: 30652151 PMCID: PMC6319663 DOI: 10.1186/s42155-018-0026-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/28/2018] [Indexed: 12/18/2022] Open
Abstract
Background Despite decreasing sheath diameter, access site bleeding and vascular complications are still a major concern in transfemoral aortic valve implantation (TAVI), and may increase morbidity and even increase mortality. The aim was to compare safety of arterial closure in transfemoral TAVI with two different principles, pre-suture with ProGlide and collagen plug closure with Manta. Results Seventy-six patients treated with ProGlide and 75 with Manta were analysed. The endpoints were 1: access site vascular complications and 2: non-planned vascular or endovascular surgery at the puncture site. Complications occurred in 2 (2.7%) ProGlide and in 8 (10.7%) Manta cases, p = 0.047. During the learning phase there were no significant differences. In the established phase there was one event (2%) in the ProGlide group, compared to 6 endpoints (12.0%), p = 0.047, in the Manta group. Unplanned surgery or intervention was seen in two (2.7%) ProGlide and in 7 (9.3%) Manta patients, p = ns. There were no significant differences during the learning phase. In established use, endpoints occurred more frequently in patients treated with the Manta device (12%), than in patients treated with the ProGlide (2%), p = 0.047. Conclusion The ProGlide presuture closure device was associated with significantly lower rates of vascular complications and lower rates of surgery and interventions compared to the collagen plug Manta system. Trial registration The data were collected from Internal quality control registry on treatment of patients with valvular heart disease with or without coronary artery disease, No 2014/17280, Oslo University Hospital, Ullevål.
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Affiliation(s)
- Pavel Hoffmann
- 1Department of Cardiology, Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Ahmed Al-Ani
- 1Department of Cardiology, Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Thomas von Lueder
- 2Department of Cardiology B, Division of Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Jenny Hoffmann
- 3The Lundberg Laboratory, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Majak
- 4Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Ove Hagen
- 5Department of Anesthesiology, Division of Emergencies and Critical care, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Helga Loose
- 6Department of Vascular Diseases, Section for Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Nils Einar Kløw
- Department of Radiology, Section for Interventional Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Ullevål, and Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anders Opdahl
- 1Department of Cardiology, Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
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Rogers T, Gai J, Torguson R, Okubagzi PG, Shults C, Ben-Dor I, Satler LF, Waksman R. Predicted magnitude of alternate access in the contemporary transcatheter aortic valve replacement era. Catheter Cardiovasc Interv 2018; 92:964-971. [DOI: 10.1002/ccd.27668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/02/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
- Cardiovascular Branch, Division of Intramural Research; National Heart Lung and Blood Institute, National Institutes of Health; Bethesda Maryland
| | - Jiaxiang Gai
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Petros G. Okubagzi
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Christian Shults
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center; Washington District of Columbia
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Tonolini M, Ierardi AM, Carrafiello G, Laganà D. Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin. Insights Imaging 2018; 9:631-642. [PMID: 29675625 PMCID: PMC6108968 DOI: 10.1007/s13244-018-0613-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/14/2018] [Accepted: 02/19/2018] [Indexed: 12/19/2022] Open
Abstract
Abstract The number and complexity of endovascular procedures performed via either arterial or venous access are steadily increasing. Albeit associated with higher morbidity compared to the radial approach, the traditional common femoral artery remains the preferred access site in a variety of cardiac, aortic, oncologic and peripheral vascular procedures. Both transarterial and venous cannulation (for electrophysiology, intravenous laser ablation and central catheterisation) at the groin may result in potentially severe vascular access site complications (VASC). Furthermore, vascular and soft-tissue groin infections may develop after untreated VASC or secondarily to non-sterile injections for recreational drug use. VASC and groin infections require rapid diagnosis and appropriate treatment to avoid further, potentially devastating harm. Whereas in the past colour Doppler ultrasound was generally used, in recent years cardiologists, vascular surgeons and interventional radiologists increasingly rely on pelvic and femoral CT angiography. Despite drawbacks of ionising radiation and the need for intravenous contrast, multidetector CT rapidly and consistently provides a panoramic, comprehensive visualisation, which is crucial for correct choice between conservative, endovascular and surgical management. This paper aims to provide radiologists with an increased familiarity with iatrogenic and self-inflicted VASC and infections at the groin by presenting examples of haematomas, active bleeding, pseudoaneurysms, arterial occlusion, arterio-venous fistula, endovenous heat-induced thrombosis, septic thrombophlebitis, soft-tissue infections at the groin, and late sequelae of venous injuries. Teaching Points • Complications may develop after femoral arterial or venous access for interventional procedures. • Arterial injuries include bleeding, pseudoaneurysm, occlusion, arteriovenous fistula, dissection. • Endovenous heat-induced thrombosis is a specific form of iatrogenic venous complication. • Iatrogenic infections include groin cellulitis, abscesses and septic thrombophlebitis. • CT angiography reliably triages vascular access site complications and groin infections.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Domenico Laganà
- Department of Radiology, "Magna Grecia" University, Viale Europa, 88100, Catanzaro, Italy
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Characteristics of aorto-iliofemoral arterial tree according to aortic valve morphology in chinese patients considered for TAVR. Int J Cardiovasc Imaging 2018; 34:1135-1142. [PMID: 29396829 DOI: 10.1007/s10554-018-1310-8] [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: 12/07/2017] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
To characterize the anatomy of aorto-iliofemoral arterial tree according to aortic valve phenotype by CT in patients referred for transcatheter aortic valve replacement (TAVR). We retrospectively enrolled 215 patients screened for TAVR who underwent CT. Dimensions, calcification, vascular tortuosity index score and other putative risk features of 13 different regions were evaluated for bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) morphology. The study consisted of 44% BAVs with younger age than TAVs. The dimensions of the annulus, sinus of Valsalva, ascending aorta and aortic arch were consistently larger in BAVs. The prevalence of calcification of aortic arch was significantly higher in TAVs even after adjustment for atherosclerotic risk factors. BAVs was associated with two-fold higher odds of having over I degree AA calcification (odds ratio 2.02; 95% CI 1.60-5.31; p < 0.001). The prevalence of severe iliac tortuosity was higher among BAVs (11.7 vs. 2.5%, p = 0.015). BAVs had a trend to more atheroma than TAVs in the abdominal aortic artery and iliofemoral artery. BAV anatomy is common in Chinese AS patients screened for TAVR. Aorto-iliofemoral pathology varies according to aortic valve phenotype, which may contribute to technical challenges in BAV vs. TAV anatomy and support the need for the integrated risk assessment for each valve phenotype.
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Toppen W, Suh W, Aksoy O, Benharash P, Bowles C, Shemin RJ, Kwon M. Vascular Complications in the Sapien 3 Era: Continued Role of Transapical Approach to Transcatheter Aortic Valve Replacement. Semin Thorac Cardiovasc Surg 2018. [DOI: 10.1053/j.semtcvs.2018.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Goldsweig AM, Kennedy KF, Kolte D, Abbott JD, Gordon PC, Sharaf BL, Sellke FW, Ehsan A, Sodha NR, Rutar F, Aronow HD. Predictors of patient radiation exposure during transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2017; 92:768-774. [DOI: 10.1002/ccd.27452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/15/2017] [Accepted: 12/02/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Andrew M. Goldsweig
- Division of Cardiology; University of Nebraska Medical Center; Omaha Nebraska
- Division of Cardiology; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
| | - Kevin F. Kennedy
- Midwest Bioinformatics; St. Luke's Mid America Heart Institute; Kansas City Missouri
| | - Dhaval Kolte
- Division of Cardiology; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
| | - J. Dawn Abbott
- Division of Cardiology; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
| | - Paul C. Gordon
- Division of Cardiology; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
| | - Barry L. Sharaf
- Division of Cardiology; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
| | - Frank W. Sellke
- Division of Cardiology; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
| | - Afshin Ehsan
- Division of Cardiology; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
| | - Neel R. Sodha
- Division of Cardiology; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
| | - Frank Rutar
- Department of Radiation Safety; University of Nebraska Medical Center; Omaha Nebraska
| | - Herbert D. Aronow
- Division of Cardiology; Warren Alpert Medical School of Brown University; Providence Rhode Island
- Lifespan Cardiovascular Institute; Providence Rhode Island
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Ando T, Akintoye E, Telila T, Briasoulis A, Takagi H, Grines CL, Afonso L. Trends in Vascular Complications in High-Risk Patients Following Transcatheter Aortic Valve Replacement in the United States. Am J Cardiol 2017; 119:1433-1437. [PMID: 28256249 DOI: 10.1016/j.amjcard.2017.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 01/09/2023]
Abstract
Vascular complications (VC) following transcatheter aortic valve replacement (TAVR) are associated with worse outcomes. The trend of VC incidence in patients considered high risk is unclear. We sought to assess the trend of VC after TAVR in patients at high risk. We investigated the VC trend in female, diabetes mellitus, and peripheral vascular disease (PVD) patients. Patients who underwent TAVR from 2011 to 2014 in the United States were identified using the International Classification of Diseases-Ninth Revision code 35.05 from the Nationwide Inpatient Sample database. Frequency of any VC (per 100 transcatheter aortic valve implantation procedure or hospital discharges) for each year from 2011 to 2014 was assessed for the overall population as well as within each category of high-risk cohorts. The overall VC rate was 6.0% (2,044/33,790). Patients who had VC were more likely to be female and had higher rates of PVD at baseline. The annual rate of VC in the overall population from 2011 to 2014 was 4.6%, 9.4%, 6.8%, and 4.4%, respectively. There was a significant increase in VC rate from 2011 to 2012 (p = 0.03), whereas there was a significant decrease in VC rate from 2012 to 2014 (p <0.001). The rate of VC between 2011 and 2014 was similar (p = 0.82). The rate of VC did not increase in any of the high-risk groups from 2011 to 2012. However, the rate of VC from 2012 to 2014 decreased significantly in all the high-risk groups. The VC rate was similar for groups between 2011 and 2014. The overall VC rate among TAVR patients initially increased from 2011 to 2012 but decreased thereafter. Similar trend in VC rate was found among high-risk patients except that the initial increase in rates from 2011 to 2012 did not reach statistical significance. Whether further reduction in VC with improvement in devices and operator/center experience for both overall and high-risk groups in TAVR occurs will require continuous longitudinal monitoring.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Wayne State University, Harper University/Detroit Medical Center, Detroit, Michigan.
| | - Emmanuel Akintoye
- Division of Cardiology, Wayne State University, Harper University/Detroit Medical Center, Detroit, Michigan
| | - Tesfaye Telila
- Division of Cardiology, Wayne State University, Harper University/Detroit Medical Center, Detroit, Michigan
| | | | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Cindy L Grines
- Division of Cardiology, Detroit Medical Center, Detroit, Michigan
| | - Luis Afonso
- Division of Cardiology, Wayne State University, Harper University, Detroit, Michigan
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Comparison of Hospital Outcome of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Diabetes Mellitus (from the Nationwide Inpatient Sample). Am J Cardiol 2017; 119:1250-1254. [PMID: 28219665 DOI: 10.1016/j.amjcard.2016.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 12/20/2022]
Abstract
The comparative outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in diabetes mellitus (DM) patients are scarce. We aimed to assess and compare the outcomes of TAVR versus SAVR in DM patients using the Nationwide Inpatient Sample database from 2011 to 2013. A complete case analysis was performed for the multivariate analysis and cases with missing data were excluded. The primary end point was in-patient all-cause mortality and secondary outcomes were perioperative complications. An estimated 5,719 TAVR procedures and 65,096 SAVR procedures were performed among DM patients in the United States between 2011 and 2013. TAVR patients were older (80 ± 8.1 vs 70 ± 10, p <0.001), majority of them were women (45% vs 38%, p <0.001), and predominantly white race (total of 80%). The adjusted odds ratio (OR) for the primary outcome was significantly lower in TAVR patients (2.8% vs 3.6%, OR 0.63, p = 0.02). TAVR patients were also at lower risk for bleeding requiring transfusions (13% vs 20%, OR 0.43, p <0.01), cardiac complications (6.1% vs 14%, OR 0.34, p <0.01), respiratory complications (1.2% vs 3.7%, OR 0.26, p <0.01), postoperative sepsis (1.7% vs 3.6%, OR 0.45, p = 0.03), and acute myocardial infarction (2.5% vs 2.9%, OR 0.62, p <0.01), compared with SAVR patients. Conversely, TAVR patients were at increased risk for vascular complications (5.7% vs 3.9%, OR 1.5, p <0.01) and new pacemaker implantation (10% vs 5.7%, OR 1.5, p <0.01). The mean hospitalization cost was lower for TAVR than SAVR ($58,878 vs $63,869, p = 0.003). Length of stay (median 6 vs 8 days, p <0.001) was shorter in TAVR patients. In conclusion, TAVR may result in better in-hospital outcome than SAVR in DM patients.
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