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Katsaros O, Apostolos A, Ktenopoulos N, Koliastasis L, Kachrimanidis I, Drakopoulou M, Korovesis T, Karanasos A, Tsalamandris S, Latsios G, Synetos A, Tsioufis K, Toutouzas K. Transcatheter Aortic Valve Implantation Access Sites: Same Goals, Distinct Aspects, Various Merits and Demerits. J Cardiovasc Dev Dis 2023; 11:4. [PMID: 38248874 PMCID: PMC10817029 DOI: 10.3390/jcdd11010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/03/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been established as a safe and efficacious treatment for patients with severe symptomatic aortic stenosis (AS). Despite being initially developed and indicated for high-surgical-risk patients, it is now offered to low-risk populations based on the results of large randomized controlled trials. The most common access sites in the vast majority of patients undergoing TAVI are the common femoral arteries; however, 10-20% of the patients treated with TAVI require an alternative access route, mainly due to peripheral atherosclerotic disease or complex anatomy. Hence, to achieve successful delivery and implantation of the valve, several arterial approaches have been studied, including transcarotid (TCr), axillary/subclavian (A/Sc), transapical (TAp), transaortic (TAo), suprasternal-brachiocephalic (S-B), and transcaval (TCv). This review aims to concisely summarize the most recent literature data and current guidelines as well as evaluate the various access routes for TAVI, focusing on the indications, the various special patient groups, and the advantages and disadvantages of each technique, as well as their adverse events.
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Affiliation(s)
- Odysseas Katsaros
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
- Department of Cardiology, University of Brussels, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Ioannis Kachrimanidis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Theofanis Korovesis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Antonios Karanasos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Sotirios Tsalamandris
- Department of Cardiology, Hippokration General Hospital of Athens, 11527 Athens, Greece;
| | - George Latsios
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
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Abellan C, Antiochos P, Fournier S, Skali H, Shah P, Maurizi N, Eeckhout E, Roguelov C, Monney P, Tzimas G, Kirsch M, Muller O, Lu H. Extrathoracic Against Intrathoracic Vascular Accesses for Transcatheter Aortic Valve Replacement: A Systematic Review With Meta-Analysis. Am J Cardiol 2023; 203:473-483. [PMID: 37633682 DOI: 10.1016/j.amjcard.2023.07.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/14/2023] [Indexed: 08/28/2023]
Abstract
Alternative vascular accesses to transfemoral access for transcatheter aortic valve replacement (TAVR) can be divided into intrathoracic (IT)-transapical and transaortic- and extrathoracic (ET)-transcarotid, transsubclavian, and transaxillary. This study aimed to compare the outcomes and safety of IT and ET accesses for TAVR as alternatives to transfemoral access. A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all studies comparing IT-TAVR with ET-TAVR published until April 2023. Outcomes included in-hospital or 30-day all-cause mortality (ACM), 1-year ACM, postoperative and 30-day complications. A total of 18 studies with 6,800 IT-TAVR patients and 5,032 ET-TAVR patients were included. IT accesses were associated with a significantly higher risk of in-hospital or 30-day ACM (relative risk 1.99, 95% confidence interval 1.67 to 2.36, p <0.001), and 1-year ACM (relative risk 1.31, 95% confidence interval 1.21 to 1.42, p <0.001). IT-TAVR patients presented more often with postoperative life-threatening bleeding, 30-day new-onset atrial fibrillation or flutter, and 30-day acute kidney injury needing renal replacement therapy. The risks of postoperative permanent pacemaker implantation and significant paravalvular leak were lower with IT-TAVR. ET-TAVR patients were more likely to be directly discharged home. There was no statistically significant difference regarding the 30-day risk of stroke. Compared with ET-TAVR, IT-TAVR was associated with higher risks of in-hospital or 30-day ACM, 1-year ACM and higher risks for some critical postprocedural and 30-day complications. Our results suggest that ET-TAVR could be considered as the first-choice alternative approach when transfemoral access is contraindicated.
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Affiliation(s)
- Christophe Abellan
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Panagiotis Antiochos
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pinak Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Niccolo Maurizi
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christan Roguelov
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgios Tzimas
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Service of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henri Lu
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Stowell JT, McComb BL, Mendoza DP, Cahalane AM, Chaturvedi A. Axillary Anatomy and Pathology: Pearls and "Pitfalls" for Thoracic Imagers. J Thorac Imaging 2022; 37:W28-W40. [PMID: 35142752 DOI: 10.1097/rti.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The axilla contains several important structures which exist in a relatively confined anatomic space between the neck, chest wall, and upper extremity. While neoplastic lymphadenopathy may be among the most common axillary conditions, many other processes may be encountered. For example, expanded use of axillary vessels for access routes for endovascular procedures will increase the need for radiologists to access vessel anatomy, patency, and complications that may arise. Knowledge of axillary anatomy and pathology will allow the imager to systematically evaluate the axillae using various imaging modalities.
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Affiliation(s)
| | | | - Dexter P Mendoza
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Health System, New York
| | | | - Abhishek Chaturvedi
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
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Combined Coronary CT Angiography and Evaluation of Access Vessels for TAVR Patients in Free-Breathing with Single Contrast Medium Injection Using a 16-cm-Wide Detector CT. Acad Radiol 2021; 28:1662-1668. [PMID: 32859475 DOI: 10.1016/j.acra.2020.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 02/05/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the feasibility of combining coronary computed tomography (CT) angiography (CCTA) and CTA to evaluate access vessels for transcatheter aortic valve replacement (TAVR) patients in free-breathing and with single contrast medium injection using a 16-cm-wide detector CT. MATERIALS AND METHODS One hundred and twenty-one consecutive patients (73.33 ± 6.43 years) referred for TAVR underwent a serious CT scans in free-breathing after one contrast injection: ECG-triggered one-heartbeat axial CCTA, followed by non-ECG-gated neck, thoracic, and abdominal CTA. Patient weight-dependent contrast dose volume at 1.0 mL/kg was used. CT attenuation values of the coronary, neck, aortic, iliac, and femoral arteries were measured and their image quality was evaluated with a 4-point score method. Stenosis (≥50%) in CCTA was evaluated using invasive coronary angiography result as a reference standard. Radiation and contrast doses were assessed. RESULTS The total dose-length-product for the entire examination was 411.4 ± 91.2 mGy.cm, and the total contrast dose was 57.3 ± 9.9 mL. There were adequate attenuations (>400 HU) in all arteries, and the peripheral access vessels and aortic annulus were evaluable in all patients. In neck CTA, 5 patients had vascular tortuosity, 6 patients had aberrant arteries and there were 212 plaques and 13 severe stenoses among the patients. In CCTA, on the per-segment, per-vessel, and per-patient analysis, CCTA showed a sensitivity and negative predictive value of (95% and 99%), (95% and 99%), and (96% and 98%), respectively, for the entire patient cohort, and (92% and 98%), (92% and 98%), and (88% and 93%), respectively, for patients with atrial fibrillation or heart rate higher than 75 beats. CONCLUSION It is feasible to perform a combined CCTA and CTA for evaluating access vessels for TAVR patients in free-breathing with single contrast injection. This approach generates acceptable image quality for all vessels and a high negative predictive value in excluding coronary artery disease with relatively low radiation and contrast doses.
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Tagliari AP, Saadi RP, Ferrari E, Taramasso M, Saadi EK. The Role of the Axillary Artery as a Second Access Choice in TAVI Procedures. Braz J Cardiovasc Surg 2021; 36:237-243. [PMID: 33355810 PMCID: PMC8163263 DOI: 10.21470/1678-9741-2020-0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
With transcatheter aortic valve implantation (TAVI) technology expanding its indications for low-risk patients, the number of TAVI-eligible patients will globally grow, requiring a better understanding about the second-best access choice. Regarding the potential access sites, the transfemoral retrograde route is recognized as the standard approach and first choice according to current guidelines. However, this approach is not suitable in up to 10-15% of patients, for whom an alternative non-femoral access is required. Among the alternative non-femoral routes, the transaxillary approach has received increasing recognition due to its proximity and relatively straight course from the axillary artery to the aortic annulus, which provides a more accurate device deployment. Here we discuss some particular aspects of the transaxillary access, either percutaneously performed or by cutdown dissection.
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Affiliation(s)
- Ana Paula Tagliari
- Department of Cardiac Surgery, University Hospital of Zurich, University Heart Center Zurich, Zurich, Switzerland.,Department of Cardiovascular Surgery, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.,Postgraduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo Petersen Saadi
- Postgraduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Department of Cardiovascular Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Enrico Ferrari
- Department of Cardiac Surgery, University Hospital of Zurich, University Heart Center Zurich, Zurich, Switzerland.,Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Maurizio Taramasso
- Department of Cardiac Surgery, University Hospital of Zurich, University Heart Center Zurich, Zurich, Switzerland
| | - Eduardo Keller Saadi
- Department of Cardiovascular Surgery, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.,Department of Cardiovascular Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
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Mitsis A, Eftychiou C, Eteokleous N, Papadopoulos K, Zittis I, Avraamides P. Current Trends in TAVI Access. Curr Probl Cardiol 2021; 46:100844. [PMID: 33994035 DOI: 10.1016/j.cpcardiol.2021.100844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
The optimal approach for Transcatheter aortic valve implantation (TAVI) is the transfemoral access but alternative TAVI approaches offer the possibility of valve replacement in patients who are not eligible to the transfemoral route. This review paper intends to compare the current available alternative approaches for TAVI in terms of their safety and efficacy, based on the current literature. The transapical, transaortic, transsubclavian, transcarotid, transcaval and suprasternal approaches have been analyzed. The choice of the alternative approach dependents on local Heart Team expertise, patient specific characteristics, access specific characteristics and the need or not for general anesthesia. More studies are needed to investigate the impact of each individual approach on long-term outcomes.
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Affiliation(s)
- Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, 2029, Nicosia, Cyprus.
| | | | | | | | - Ioannis Zittis
- Cardiology Department, Nicosia General Hospital, 2029, Nicosia, Cyprus
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Amat-Santos IJ, Santos-Martínez S, Conradi L, Taramasso M, Poli A, Romaguera R, Pan M, Bagur R, Del Valle R, Nombela-Franco L, Bhadra OD, Aparisi Á, Redondo A, Gutiérrez H, Gómez I, Roman JAS. Transaxillary transcatheter ACURATE neo aortic valve implantation - The TRANSAX multicenter study. Catheter Cardiovasc Interv 2020; 98:E291-E298. [PMID: 33315296 DOI: 10.1002/ccd.29423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/25/2020] [Accepted: 11/29/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) via transaxillary (TAx) approach with ACURATE neo valve is an off-label procedure. Our aim was to gather information on ACURATE neo cases implanted via TAx approach and report major outcomes. METHODS AND RESULTS The TRANSAX Study (NCT04274751) retrospectively gathered patients from nine centres in Europe and North America treated with ACURATE neo valve through TAx approach up to May/2019. Follow up was pre-specified at 1-year and was obtained for all patients. A total of 75 patients (79 ± 10 years; 32% women) were included. Left axillary (72%) and conscious sedation (95.2%) were the most common setting. Risk scores were higher when right axillary artery and surgical cut-down were selected. Severe complications including valve embolization, coronary obstruction, annulus rupture, and procedural mortality did not occur. Cardiac tamponade occurred in two cases (2.7%) with one requiring conversion to open surgery (1.3%). Bail-out stenting and surgical vascular repair were required in 7 (9.3%) and 3 (4%) cases, respectively. The need for new permanent pacemaker was 8%. Procedural success (96%), in-hospital (2.7%), and 1-year mortality (8%) were comparable in all settings. Only one case (1.3%) complicated with cerebrovascular event and one (1.3%) presented moderate aortic regurgitation before discharge. CONCLUSIONS TAx TAVR procedures with the ACURATE neo valve were presented high success rate and low in-hospital and 1-year mortality.
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Affiliation(s)
| | | | - Lenard Conradi
- Department of Cardiovascular Surgery, Universitäres Herz und Gefäßzentrum, Hamburg, Germany
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, UniversitätsSpital, Zürich, Switzerland
| | - Arnaldo Poli
- Interventional Cardiology Department, ASST Ovest Milanese- Ospedale di Legnano, Milan, Italy
| | - Rafael Romaguera
- Cardiology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Manuel Pan
- Cardiology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Rodrigo Bagur
- Cardiology Division, London Health Sciences Centre, Department of Medicine, Western University, London, Ontario, Canada
| | - Raquel Del Valle
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Nombela-Franco
- Cardiology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, Universitäres Herz und Gefäßzentrum, Hamburg, Germany
| | - Álvaro Aparisi
- CIBERCV, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | - Itziar Gómez
- CIBERCV, Hospital Clínico Universitario, Valladolid, Spain
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Zhan Y, Toomey N, Ortoleva J, Kawabori M, Weintraub A, Chen FY. Safety and efficacy of transaxillary transcatheter aortic valve replacement using a current-generation balloon-expandable valve. J Cardiothorac Surg 2020; 15:244. [PMID: 32912309 PMCID: PMC7488327 DOI: 10.1186/s13019-020-01291-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background Transaxillary access (TAx) has shown promise as an excellent alternative TAVR option, but data on the Edwards SAPIEN 3 in TAx-TAVR is limited. We sought to study the safety and efficacy of TAx-TAVR using this current-generation balloon-expandable valve. Methods A retrospective study of our first 24 TAx and 20 transthoracic (TT) TAVR patients treated with the SAPIEN 3 valve was performed, and the patients’ preoperative characteristics, procedural outcomes, and clinical outcomes were compared to our first 100 transfemoral (TF) patients using the SAPIEN 3 device. Results There were no statistical differences observed for outcomes between the TAx and TF groups, despite the TAx patients having more comorbidities (STS-PROM 11.3 ± 7.6 versus 7.3 ± 5.2, p = 0.042). In addition, no significant difference was found in the fluoroscopy time and contrast amount between the two groups. The patients’ baseline characteristics were similar between the TAx and TT groups. Their procedural and clinical outcomes were comparable, but there was a trend towards lower incidence of acute kidney injury (13.0% versus 23.5%), new-onset atrial fibrillation (5.6% versus 33.3%), shorter median length of stay postoperatively (4 versus 6 days), fewer discharges to rehabilitation (16.7% versus 35.0%), and a lower rate of readmission within 30-days (8.3% versus 35.0%), all favoring TAx access. Conclusions TAx-TAVR with the SAPIEN 3 valve is a safe alternative to TF access. It offers advantages of improved recovery over TT access, and appears to be a superior alternative-access option for TAVR. TAx access could be preferred when TF access is not feasible.
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Affiliation(s)
- Yong Zhan
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, #266, Boston, MA, 02111, USA.
| | - Nicholas Toomey
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, #266, Boston, MA, 02111, USA
| | - Jamel Ortoleva
- Division of Cardiac Anesthesia, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Masashi Kawabori
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, #266, Boston, MA, 02111, USA
| | - Andrew Weintraub
- Division of Cardiology, CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Frederick Y Chen
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, #266, Boston, MA, 02111, USA
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Kuo F, Park J, Chow K, Chen A, Walsworth MK. Avoiding peripheral nerve injury in arterial interventions. ACTA ACUST UNITED AC 2020; 25:380-391. [PMID: 31310240 DOI: 10.5152/dir.2019.18296] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although peripheral nerve injuries secondary to angiography and endovascular interventions are uncommon and usually not permanent, they can result in significant functional impairment. Most arteries used in access for angiography and endovascular therapies lie in close proximity to a nerve. The nerve may be injured by needle puncture, or by compression from hematoma, pseudoaneurysm, hemostasis devices, or by manual compression with incidence in literature ranging from as low as 0.04% for femoral access in a large retrospective study to 9% for brachial and axillary access. Given the increasing frequency of endovascular arterial procedures and the increasing use of nontraditional access points, it is important that the interventionalist have a working knowledge of peripheral nerve anatomy and function as it relates to relevant arterial access sites to avoid injury.
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Affiliation(s)
- Frank Kuo
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Park
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kira Chow
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Alice Chen
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Matthew K Walsworth
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
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10
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Pour-Ghaz I, Raja J, Bayoumi M, Manolukas T, Khouzam RN, Ibebuogu UN. Transcatheter aortic valve replacement with a focus on transcarotid: a review of the current literature. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:420. [PMID: 31660319 DOI: 10.21037/atm.2019.07.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Valve replacement in high-risk patients with severe aortic stenosis has undergone a huge paradigm shift in the recent years in terms of procedural details and vascular access site for patients who have poor peripheral access. Carotid artery is one of the more promising access sites which has been proven to provide a good alternative site with comparable outcomes to transfemoral approach. In this manuscript, we will provide a review of the current literature on transaortic, transapical, transaxillary and transcarotid approaches to transcatheter aortic valve replacement (TAVR) while focusing on the transcarotid approach.
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Affiliation(s)
- Issa Pour-Ghaz
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joel Raja
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mahmoud Bayoumi
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Theodore Manolukas
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Zhan Y, Kawabori M, Lofftus S, Cobey F, Rastegar H, Weintraub A, Chen FY. Right Transaxillary Transcatheter Aortic Valve Replacement Using the "Flip-n-Flex" Technique. Ann Thorac Surg 2019; 109:57-62. [PMID: 31279789 DOI: 10.1016/j.athoracsur.2019.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/20/2019] [Accepted: 05/08/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Right transaxillary transcatheter aortic valve replacement (TAx-TAVR) is rarely performed due to challenging vascular tortuosity and unfavorable implantation angles. We explored this procedure using the newer-generation balloon-expandable SAPIEN 3 (Edwards Lifesciences, Irvine, CA) valve and our novel "flip-n-flex" technique. The safety and effectiveness of the procedure and the learning curve of our early experiences were investigated. METHODS The first 10 consecutive patients undergoing right TAx-TAVR performed at our center from June 2016 to May 2018 were included in the study. Patients' preoperative characteristics, procedural outcomes, and clinical outcomes were studied. Intraoperative fluoroscopy times were also reviewed to analyze the procedural learning curve. RESULTS The 10 patients were a mean age of 81.8 ± 8.7 years, and 5 patients (50%) were women. Mean Society of Thoracic Surgeons Predicted Risk of Mortality was 12.0% ± 9.5%. Procedural success was achieved in all cases without vascular complications. Paravalvular leak was absent or mild in all patients. Two patients (20%) required permanent pacemaker implantation. The median postoperative length of stay was 4 days (range, 2-13 days). The 30-day mortality was 0%. Mean transvalvular gradient improved from 38.4 ± 12.6 mm Hg to 9 ± 4.4 mm Hg postoperatively. New York Heart Association Functional Classification improved in all patients. The fluoroscopy time showed marked reduction from 44.1 ± 8.2 minutes to 17.4 ± 2.9 minutes with the use of the flip-n-flex technique. CONCLUSIONS Our early experience of right TAx-TAVR with the SAPIEN 3 valve demonstrated satisfactory outcomes and a quick learning as facilitated by the flip-n-flex technique. This could be a beneficial TAVR approach to suitable patients.
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Affiliation(s)
- Yong Zhan
- Division of Cardiac Surgery, Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
| | - Masashi Kawabori
- Division of Cardiac Surgery, Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Serena Lofftus
- Division of Cardiac Surgery, Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Frederick Cobey
- Division of Cardiac Anesthesia, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Hassan Rastegar
- Division of Cardiac Surgery, Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Andrew Weintraub
- Division of Cardiology, Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Frederick Y Chen
- Division of Cardiac Surgery, Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Porterie J, Mayeur N, Lhermusier T, Dumonteil N, Chollet T, Lairez O, Marcheix B. Aortic and innominate routes for transcatheter aortic valve implantation. J Thorac Cardiovasc Surg 2019; 157:1393-1401.e7. [DOI: 10.1016/j.jtcvs.2018.07.098] [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: 01/06/2018] [Revised: 06/25/2018] [Accepted: 07/08/2018] [Indexed: 11/29/2022]
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13
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McKiernan M, Lisko J, Grubb KJ. Alternative TAVR Access: Is It Time to Alter Your Alternative Access Strategy? Semin Thorac Cardiovasc Surg 2018; 31:181-182. [PMID: 30359731 DOI: 10.1053/j.semtcvs.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Maureen McKiernan
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John Lisko
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Kendra J Grubb
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
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14
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Feasibility and Outcomes of Transcatheter Aortic Valve Implantation Using the Left Axillary Artery as Primary Access Site. Ann Thorac Surg 2018; 107:546-552. [PMID: 30292844 DOI: 10.1016/j.athoracsur.2018.07.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The femoral artery is generally used as primary access for transcatheter aortic valve implantation. However, peripheral artery disease often precludes femoral access. The purpose of this study was to describe clinical outcome of transcatheter aortic valve implantation using the left axillary artery (LAA) as primary access site. METHODS From December 2008 until June 2016, data on all consecutive patients treated with a Medtronic device through the LAA at our hospital were registered, and outcome was prospectively collected according to the updated Valve Academic Research Consortium-2 criteria. Mortality check was performed nationally. RESULTS In total, 362 patients were included (median age 80 years [range, 76 to 84]; logistic European System for Cardiac Operative Risk Evaluation 17% ± 12%). Successful axillary access was achieved in 99%. Medtronic CoreValve (86%) and Evolut R (14% [Medtronic, Minneapolis, MN]) were implanted. Major vascular complications occurred in 5% of patients, 1% was LAA related. Life-threatening bleeding and major bleeding were observed in 2% and 10%, respectively. Additional complications were new left bundle branch blood (30%), new permanent pacemaker (11%), and stroke (1%). There were 6 procedural deaths (2%) and 19 deaths (5%) within 30 days. One-year mortality rate was 19%. CONCLUSIONS This is the first study reporting outcome after transcatheter aortic valve implantation using the LAA as default access. We conclude that it is highly feasible and safe with low rates of major vascular complications, bleeding, and stroke.
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15
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Parikh PB, Loh S, Gruberg L, Weinstein J, Tannous H, Bilfinger T. Simultaneous thoracic aortic endovascular graft and transfemoral transcatheter aortic valve replacement in a patient with a descending aortic thrombus. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:87-88. [PMID: 30170829 DOI: 10.1016/j.carrev.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/16/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022]
Abstract
Severe descending thoracic and abdominal aortic pathology can deter consideration of transfemoral (TF) access for transcatheter aortic valve replacement (TAVR) in adults with severe symptomatic aortic stenosis (AS) and may lead to utilization of alternative access sites. We report a case of an 88-year-old frail woman with severe symptomatic AS referred for TAVR with demonstration of a large thrombus in the descending thoracic aorta immediately distal to the left subclavian artery. Given concerns of thrombus embolization with femoral advancement of the transcatheter valve, coverage with a thoracic aortic endograft was planned immediately prior to the TAVR.
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Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, United States of America.
| | - Shang Loh
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, United States of America
| | - Luis Gruberg
- Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, United States of America
| | - Jonathan Weinstein
- Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, United States of America
| | - Henry Tannous
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, United States of America
| | - Thomas Bilfinger
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, United States of America
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16
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A Review of Alternative Access for Transcatheter Aortic Valve Replacement. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:62. [PMID: 29974264 DOI: 10.1007/s11936-018-0648-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
With the advent of transcatheter aortic valve replacement (TAVR), appropriately selected intermediate-, high-, and extreme-risk patients with severe aortic stenosis (AS) are now offered a less invasive option compared to conventional surgery. In contemporary practice, TAVR is performed predominantly via a transfemoral arterial approach, whereby a transcatheter heart valve (THV) is delivered in a retrograde fashion through the iliofemoral arterial system and thoraco-abdominal aorta, into the native aortic valve annulus. While the majority of patients possess suitable anatomy for transfemoral arterial access, there is a subset of patients with extensive peripheral vascular disease that precludes this traditional approach to TAVR. Fortunately, innovation in the field of structural heart disease has led to the refinement of alternative access options for THV delivery. Selection of the most appropriate route of therapy mandates a careful consideration of multiple factors, including patient anatomy, technical feasibility, and equipment specifications. Furthermore, understanding the risks conferred by each access site for valve delivery-notably stroke, vascular injury, and major bleeding-is of paramount importance when selecting the approach that will best optimize the outcome for an individual. In this review, we provide a comprehensive summary of alternative approaches to transfemoral arterial TAVR as well as the available outcome data supporting each of these various techniques.
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17
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TAVI transaxilar: la técnica paso a paso. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Madigan M, Atoui R. Non-transfemoral access sites for transcatheter aortic valve replacement. J Thorac Dis 2018; 10:4505-4515. [PMID: 30174904 DOI: 10.21037/jtd.2018.06.150] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transfemoral access is currently the standard and preferred access site for transcatheter aortic valve replacement (TAVR), though novel approaches are emerging to expand treatment options for the increasing numbers of patients with a contraindication for the traditional route. Previous publications have provided comparisons between two TAVR access sites, primarily transfemoral versus one of the novel approaches, while others have compared three or four novel approaches. The aim of this report is to provide a comprehensive summary of publications that analyse and compare the six non-transfemoral access sites currently described in the literature. These include the transapical, transaortic, axillary/subclavian, brachiocephalic, transcarotid, and transcaval approaches. Though there remains little consensus as to the superiority or non-inferiority of TAVR approaches, and there has yet to be randomized clinical trials to support published findings, with careful patient and procedural selection, outcomes for novel approaches have been reported to be comparable to standard transfemoral access when performed by skilled physicians. As such, choice of procedure is primarily based on registry data and the judgement of surgical teams as to which approach is best in each individual case. As TAVR continues to be an increasingly widespread treatment, search for the optimal access site will grow, and focus should be placed on the importance of educating surgeons as to all possible approaches so they may review and chose the most appropriate technique for a given patient.
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Affiliation(s)
- Mariah Madigan
- Division of Cardiac Surgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Rony Atoui
- Division of Cardiac Surgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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19
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Gleason TG, Schindler JT, Hagberg RC, Deeb GM, Adams DH, Conte JV, Zorn GL, Hughes GC, Guo J, Popma JJ, Reardon MJ. Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve Replacement Renders Equivalent Outcomes as Transfemoral. Ann Thorac Surg 2018; 105:477-483. [DOI: 10.1016/j.athoracsur.2017.07.017] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/04/2017] [Accepted: 07/10/2017] [Indexed: 11/24/2022]
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20
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Amat-Santos IJ, Rojas P, Gutiérrez H, Vera S, Castrodeza J, Tobar J, Goncalves-Ramirez LR, Carrasco M, Catala P, San Román JA. Transubclavian approach: A competitive access for transcatheter aortic valve implantation as compared to transfemoral. Catheter Cardiovasc Interv 2018; 92:935-944. [DOI: 10.1002/ccd.27485] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/16/2017] [Accepted: 12/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ignacio J. Amat-Santos
- CIBER CV, Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
- Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
| | - Paol Rojas
- Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
| | - Hipólito Gutiérrez
- CIBER CV, Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
- Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
| | - Silvio Vera
- Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
| | - Javier Castrodeza
- Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
| | - Javier Tobar
- Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
| | | | - Manuel Carrasco
- Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
| | - Pablo Catala
- Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
| | - José A. San Román
- CIBER CV, Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
- Cardiology Department; Hospital Clínico Universitario; Valladolid Spain
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21
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Multidetector computed tomography evaluation of candidates for transcatheter aortic valve implantation. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Kiser AC, Caranasos TG, Peterson MD, Holzhey DM, Kiefer P, Wiley Nifong L, Borger MA. Suprasternal Transcatheter Aortic Valve Replacement in Patients with Marginal Femoral Access. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andy C. Kiser
- East Carolina Heart Institute, East Carolina University, Greenville, NC USA
| | - Thomas G. Caranasos
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Mark D. Peterson
- St. Michael's Hospital, University of Toronto, Toronto, ON Canada
| | | | | | - L. Wiley Nifong
- East Carolina Heart Institute, East Carolina University, Greenville, NC USA
| | - Michael A. Borger
- Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University, New York, NY USA
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23
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Suprasternal Transcatheter Aortic Valve Replacement in Patients with Marginal Femoral Access. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:1-4. [DOI: 10.1097/imi.0000000000000462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access. We reviewed our multicenter experience with minimally invasive suprasternal transcatheter aortic valve replacement. Methods Consecutive patients with symptomatic severe aortic stenosis at high or intermediate risk for surgical aortic valve replacement underwent suprasternal transcatheter aortic valve replacement. A commercially available transcatheter heart valve was deployed under fluoroscopic guidance through the innominate artery or ascending aorta. Using a 3-cm skin incision just above the sternal notch, the Aegis Transit System (Aegis Surgical Ltd, Galway, Ireland) provided illuminated access to the mediastinum without bone disruption. Through a purse-string suture placed in the innominate artery or ascending aorta, transcatheter aortic valve replacement proceeded similarly to the direct aortic approach. Results Thirty patients at six medical centers successfully underwent suprasternal transcatheter aortic valve replacement. Implanted valves included 2 CoreValve and 12 Evolut-R (Medtronic, Inc, Minneapolis, MN USA), as well as 10 SAPIEN 3 and 6 SAPIEN XT (Edwards Lifesciences, Corp, Irvine, CA USA) with sizes ranging from 23 to 31 mm. Median procedure time was 90 minutes and median hospital stay was 4 days. Postoperatively, new permanent pacemaker (n = 3) was the most common Vascular Academic Research Consortium 2 complication. Conclusions These data demonstrate the early clinical feasibility of suprasternal transcatheter aortic valve replacement. Key advantages of this approach include direct access to the innominate artery and ascending aorta, precise sheath control, and confident arterial closure. Additional experience is warranted to confirm these favorable results.
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Guillén Subirán ME, Ros Mendoza LH, Angulo Herviás E, Yagüe Romeo D, Núñez Motilva ME. Multidetector computed tomography evaluation of candidates for transcatheter aortic valve implantation. RADIOLOGIA 2017; 60:24-38. [PMID: 29032806 DOI: 10.1016/j.rx.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/01/2017] [Accepted: 08/05/2017] [Indexed: 10/18/2022]
Abstract
In transcatheter aortic valve implantation (TAVI), a biologic valve mounted in a stent is implanted without removing the native valve. This procedure was first done in humans by Alain Cribier in 2002 and was included in clinical guidelines after the multicenter PARTNER (Placement of AoRtic TraNscathetER) randomized clinical trial, which showed that TAVI obtained better outcomes than conservative medical treatment and is an alternative to surgery in patients with high surgical risk. Candidates for TAVI must be assessed to determine whether the procedure is feasible, because TAVI is not ideal for all patients who are considered inoperable. Multidetector computed tomography plays an important role in the anatomic evaluation of candidates and in guiding the procedure in those who are finally selected.
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Affiliation(s)
- M E Guillén Subirán
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - L H Ros Mendoza
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - E Angulo Herviás
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - D Yagüe Romeo
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M E Núñez Motilva
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
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Bapat V, Frank D, Cocchieri R, Jagielak D, Bonaros N, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Rein KA, Verhoye JP, Gerosa G, Baumbach H, Bramlage P, Deutsch C, Thoenes M, Romano M. Transcatheter Aortic Valve Replacement Using Transaortic Access: Experience From the Multicenter, Multinational, Prospective ROUTE Registry. JACC Cardiovasc Interv 2017; 9:1815-22. [PMID: 27609256 DOI: 10.1016/j.jcin.2016.06.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The Registry of the Utilization of the TAo-TAVR approach using the Edwards SAPIEN Valve (ROUTE) was established to assess the effectiveness and safety of the use of transaortic (TAo) access for transcatheter aortic valve replacement (TAVR) procedures (NCT01991431). BACKGROUND TAVR represents an alternative to surgical valve replacement in high-risk patients. Whereas the transfemoral access route is used commonly as the first-line approach, transapical access is an option for patients not suitable for transfemoral treatment mainly due to anatomic conditions. TAo-TAVR has been shown to be a viable alternative surgical access route; however, only limited data on its effectiveness and safety has been published. METHODS ROUTE is a multicenter, international, prospective, observational registry; data were collected from 18 centers across Europe starting in February 2013. Patients having severe calcific aortic stenosis were documented if they were scheduled to undergo TAo-TAVR using an Edwards SAPIEN XT or a SAPIEN 3 valve. The primary endpoint was 30-day mortality. Secondary endpoints were intraprocedural or in hospital and 30-day complication rates. RESULTS A total of 301 patients with a mean age of 81.7 ± 5.9 years and an Society of Thoracic Surgeons score of 9.0 ± 7.6% were included. Valve success was documented in 96.7%. The 30-day mortality was 6.1% (18/293) (procedure-related mortality: 3.1%; 9 of 293). The Valve Academic Research Consortium-2 defined complications included myocardial infarction (1.0%), stroke (1.0%), transient ischemic attack (0.3%), major vascular complications (3.4%), life-threatening bleeding (3.4%), and acute kidney injury (9.5%). In 3.3% of patients, paravalvular regurgitation was classified as moderate or severe (10 of 300). Twenty-six patients (8.8%) required permanent pacemaker implantation. CONCLUSIONS TAo access for TAVR seems to be a safe alternative to the transapical procedure.
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Affiliation(s)
| | - Derk Frank
- Department of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany
| | - Ricardo Cocchieri
- Heart Center, Academic Medical Center, University of Amsterdam, Netherlands
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Poland
| | - Nikolaos Bonaros
- University Hospital for Cardiac Surgery, Medical University Innsbruck, Austria
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S. Matteo, Pavia University School of Medicine, Pavia, Italy
| | - Joel Lapeze
- Department of Cardiovascular Surgery, Hospital Louis Pradel, Lyon, France
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Sidney Chocron
- Cardiothoracic Surgery, Hospital Jean Minjoz, University Hospital of Besancon, France
| | - Douglas Muir
- Cardiothoracic Division, James Cook Hospital, Middlesbrough, United Kingdom
| | - Walter Eichinger
- Department of Cardiothoracic Surgery, Klinikum Bogenhausen, Munich, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, Germany
| | - Louis Labrousse
- Department of Cardiovascular Surgery, CHU Hospital of Bordeaux, France
| | - Kjell Arne Rein
- Department of Cardiothoracic Surgery, Rikshospital Oslo, Norway
| | | | - Gino Gerosa
- Department of Cardiac Surgery, University of Padova, Italy
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Martin Thoenes
- Edwards Lifesciences, Medical Affairs/Professional Education, Nyon, Switzerland
| | - Mauro Romano
- Institut Hospitalier Jacques Cartier, Massy, France
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Pascual I, Carro A, Avanzas P, Hernández-Vaquero D, Díaz R, Rozado J, Lorca R, Martín M, Silva J, Morís C. Vascular approaches for transcatheter aortic valve implantation. J Thorac Dis 2017; 9:S478-S487. [PMID: 28616344 DOI: 10.21037/jtd.2017.05.73] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is a rapidly evolving therapeutic modality currently available for patients with severe aortic stenosis (AS) that are unsuitable for surgery because of technical/anatomical issues or high-estimated surgical risk. Transfemoral approach is the preferred TAVI delivery route when possible. Alternative non-transfemoral access options include transaortic, trans-subclavian and transapical access. Other approaches are also feasible (transcarotid, transcaval, and antegrade aortic) but are restricted to operators and hospitals with experience. The peculiarities of each of the vascular approaches designed for TAVI delivery make it necessary to carefully assess patient's atherosclerotic load and location, arterial size and tortuosity, and presence of mural thrombus. Several clinical trials are currently ongoing and in the near future the indications for these approaches will likely be better defined and extended to a broader spectrum of TAVI candidates.
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Affiliation(s)
- Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo (Asturias), Spain
| | | | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo (Asturias), Spain
| | | | - Rocío Díaz
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo (Asturias), Spain
| | - Jose Rozado
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo (Asturias), Spain
| | - Rebeca Lorca
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo (Asturias), Spain
| | - María Martín
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo (Asturias), Spain
| | - Jacobo Silva
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo (Asturias), Spain
| | - César Morís
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo (Asturias), Spain
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Bruschi G, Colombo P, Merlanti B, Nava S, Belli O, Musca F, Soriano F, Botta L, Calini A, De Caria DF, Oliva F, Russo CF. A new access for transcatheter aortic valve implantation: Distal axillary artery. Int J Cardiol 2016; 223:810-812. [PMID: 27575782 DOI: 10.1016/j.ijcard.2016.08.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Giuseppe Bruschi
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy.
| | - Paola Colombo
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Bruno Merlanti
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Stefano Nava
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Oriana Belli
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Francesco Musca
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | | | - Luca Botta
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Angelo Calini
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | | | - Fabrizio Oliva
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Claudio F Russo
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
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When we should say no to TAVR—Defining the line between utility and futility. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:424-7. [DOI: 10.1016/j.carrev.2016.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/12/2016] [Accepted: 05/31/2016] [Indexed: 11/21/2022]
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García-González P, Estornell-Erill J, Lopez-Lereu MP, Monmeneu-Menadas JV. Evaluación previa al implante valvular aórtico transcatéter con tomografía computarizada y resonancia magnética: lo que el cirujano cardiaco necesita conocer. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Philipsen TE, Collas VM, Rodrigus IE, Salgado RA, Paelinck BP, Vrints CM, Bosmans JM. Brachiocephalic artery access in transcatheter aortic valve implantation: a valuable alternative: 3-year institutional experience. Interact Cardiovasc Thorac Surg 2015; 21:734-40. [DOI: 10.1093/icvts/ivv262] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/18/2015] [Indexed: 12/14/2022] Open
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Steinberger JD, McWilliams JP, Moriarty JM. Alternative Aortic Access: Translumbar, Transapical, Subclavian, Conduit, and Transvenous Access to the Aorta. Tech Vasc Interv Radiol 2015; 18:93-9. [DOI: 10.1053/j.tvir.2015.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Murdock JE, Jensen HA, Thourani VH. Nontransfemoral Approaches to Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2015; 4:95-105. [PMID: 28582125 DOI: 10.1016/j.iccl.2014.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is noninferior to surgical aortic valve replacement in patients with high operative risk and superior to medical treatment in patients deemed unsuitable for surgical intervention. However, up to 30% to 50% of patients screened for this intervention are not candidates for TAVR via the preferred transfemoral route because of severe peripheral arterial disease. Alternative access routes must be considered and include the transapical, transaortic, transsubclavian, and transcarotid approaches. The use of alternative access is predicated on appropriate patient selection as determined by a dedicated multispecialty heart valve team and can lead to excellent outcomes.
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Affiliation(s)
- Jared E Murdock
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, 550 Peachtree Street Northeast, Atlanta, GA 30308, USA
| | - Hanna A Jensen
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, 550 Peachtree Street Northeast, Atlanta, GA 30308, USA
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, 550 Peachtree Street Northeast, Atlanta, GA 30308, USA.
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Bruschi G, Botta L, Cannata A, Colombo P, Barosi A, Soriano F, Bottiroli M, Nava S, Klugmann S, De Marco F. First case of trans-axillary direct flow implantation. Int J Cardiol 2014; 177:e176-8. [PMID: 25189491 DOI: 10.1016/j.ijcard.2014.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Giuseppe Bruschi
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy.
| | - Luca Botta
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Aldo Cannata
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Paola Colombo
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Alberto Barosi
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Francesco Soriano
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Maurizio Bottiroli
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Stefano Nava
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Silvio Klugmann
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Federico De Marco
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
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Ramlawi B, Bedeir K, Reardon M. Reply to the editor. J Thorac Cardiovasc Surg 2014; 148:2438-9. [PMID: 25444207 DOI: 10.1016/j.jtcvs.2014.08.016] [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: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Basel Ramlawi
- Methodist DeBakey Heart and Vascular Center, Houston, Tex
| | - Kareem Bedeir
- Methodist DeBakey Heart and Vascular Center, Houston, Tex
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Direct aorta ascending approach in transcatheter aortic valve implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:1-9. [PMID: 24553056 DOI: 10.1097/imi.0000000000000046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Direct aorta ascending approach [transaortic approach (TAo)] is a new access way for transcatheter aortic valve implantation (TAVI) to be used in patients with peripheral vascular disease and as an alternative to transapical approach. METHODS Both the Edwards SAPIEN and CoreValve systems were used. Depending on the position of the ascending aorta, the relation to the sternum, the brachiocephalic vein, vein grafts, and left and right internal mammary artery grafts from previous heart surgery, either right minithoracotomy or left ministernotomy was selected. Computed tomographic scan with reconstruction was applied for this decision making. A hybrid operating room was used with echocardiographic and fluoroscopy guidance. RESULTS We have done 30 procedures via the aorta ascendens. The mean age of the patients was 80 years, and 18 were men. The mean Logistic EuroSCORE of 33 reflects the comorbidities. More than half of the patients had coronary vessel disease and had undergone coronary artery bypass graft; 20% had abdominal aortic aneurysm. The mean ejection fraction was 41%, and the patients were in New York Heart Association class III to IV. The mean gradient was 50 mm Hg, and the mean valve area was 0.7 cm. The mean valve size was 28 mm. The use of Edwards SAPIEN versus CoreValve was 50%/50%, and thoracotomy versus sternotomy was 9 versus 21. All procedures were done successfully, but one patient had a periprocedural valve-in-valve implantation. Twenty-two patients were extubated in the operation room. The patients stayed in the intensive care unit for one night. Six patients were reoperated on. One patient had a postoperative balloon aortic valvuloplasty. The overall survival was 81% (follow up, 1-18 months). CONCLUSIONS Access design is an important issue in TAVI. When central approach is needed, TAVI-TAo is safe. For patients with low ejection fraction, the TAVI-TAo is preferred to the TAVI-transapical. The cannulation technique of the aorta is well known for cardiothoracic surgeons, and the method is feasible both for the Medtronic CoreValve and the Edwards SAPIEN valve, either via right minithoracotomy or ministernotomy to obtain the best coaxial alignment. It seems easier to position the bigger valves more precisely via this central approach.
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Abstract
Transcatheter aortic valve implantation was developed to offer a therapeutic solution to patients with severe symptomatic aortic stenosis who are not candidates for conventional aortic valve replacement. The improvement in transcatheter aortic valve implantation outcomes is still of concern in the areas of stroke, vascular injury, heart block, paravalvular regurgitation and valve durability. Concomitantly, the progress, both technical and in terms of material advances of transcatheter valve systems, as well as in patient selection, renders transcatheter aortic valve implantation an increasingly viable treatment for more and more patients with structural heart disease.
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Aguirre J, Waskowski R, Poddar K, Kapadia S, Krishnaswamy A, McCullough R, Mick S, Navia JL, Roselli EE, Tuzcu ME, Sabik JF, Lytle BW, Svensson LG. Transcatheter aortic valve replacement: Experience with the transapical approach, alternate access sites, and concomitant cardiac repairs. J Thorac Cardiovasc Surg 2014; 148:1417-22. [DOI: 10.1016/j.jtcvs.2014.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 04/21/2014] [Accepted: 05/08/2014] [Indexed: 11/28/2022]
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Transcatheter Aortic Valve Implantation by the Left Axillary Approach: A Single-Center Experience. Ann Thorac Surg 2014; 97:1549-54. [DOI: 10.1016/j.athoracsur.2013.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/20/2013] [Accepted: 11/11/2013] [Indexed: 11/21/2022]
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39
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Kumpati GS, Gray R, Patel A, Bull DA. Endovascular Repair of Acute Ascending Aortic Disruption via the Right Axillary Artery. Ann Thorac Surg 2014; 97:700-3. [DOI: 10.1016/j.athoracsur.2013.05.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 05/08/2013] [Accepted: 05/15/2013] [Indexed: 10/25/2022]
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40
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Rajagopal R, More RS, Roberts DH. Transcatheter aortic valve implantation through a transcarotid approach under local anesthesia. Catheter Cardiovasc Interv 2014; 84:903-7. [DOI: 10.1002/ccd.25367] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 11/04/2013] [Accepted: 12/21/2013] [Indexed: 11/10/2022]
Affiliation(s)
| | - Ranjit S. More
- Lancashire Cardiac Centre; Blackpool Teaching Hospitals; Blackpool United Kingdom
| | - David H. Roberts
- Lancashire Cardiac Centre; Blackpool Teaching Hospitals; Blackpool United Kingdom
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41
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Dahle G, Rein KA. Direct Aorta Ascending Approach in Transcatheter Aortic Valve Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gry Dahle
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Kjell-Arne Rein
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
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Toggweiler S, Leipsic J, Binder RK, Freeman M, Barbanti M, Heijmen RH, Wood DA, Webb JG. Management of Vascular Access in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2013; 6:643-53. [DOI: 10.1016/j.jcin.2013.04.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/29/2013] [Accepted: 04/11/2013] [Indexed: 12/17/2022]
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43
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Bapat V, Attia R. Transaortic Transcatheter Aortic Valve Implantation: Step-by-Step Guide. Semin Thorac Cardiovasc Surg 2013. [PMID: 23200076 DOI: 10.1053/j.semtcvs.2012.06.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is currently used to treat high-risk and inoperable patients with aortic stenosis. The established routes of access are retrograde transfemoral (TF) and antegrade transapical (TA). Transubclavian and transaortic (TAo) routes have been described. We have performed TAo-TAVI with the Edwards Sapien prosthesis (Edwards Lifesciences, Irvine, CA) with the Ascendra I delivery system. From 2010 we have used the Sapien XT prosthesis with the Ascendra II delivery system. In this article we describe in detail the technical aspects of performing TAo TAVI.
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Affiliation(s)
- Vinnie Bapat
- Department of Cardiothoracic Surgery, St Thomas' Hospital, London, United Kingdom.
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Bruschi G, De Marco F, Martinelli L, Klugmann S. CoreValve® transcatheter self-expandable aortic bioprosthesis. Expert Rev Med Devices 2013; 10:15-26. [PMID: 23278219 DOI: 10.1586/erd.12.64] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve implantation has been designed to treat patients affected by severe symptomatic aortic stenosis considered extremely high risk for surgical aortic valve replacement. The CoreValve® (Medtronic Inc., MN, USA) is a multilevel self-expanding and fully radiopaque nitinol frame with a diamond cell configuration that holds a trileaflet porcine pericardial tissue valve and anchors the device in the native anatomy. CoreValve was the first percutaneous valve to be granted the CE mark for transfemoral implantation in May 2007 and the CoreValve US Pivotal Trial is actively underway. The CoreValve is available in four sizes (23, 26, 29 and 31 mm) to serve a broad range of patients' annulus from 18 to 29 mm. All the valves fit into an 18-Fr size catheter. Currently, more than 35,000 patients have been treated in more than 60 countries worldwide from the femoral artery, the axillary artery and, more recently, from a direct aortic approach, with excellent results up to 4-year follow-up.
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Affiliation(s)
- Giuseppe Bruschi
- A. De Gasperis Cardiology and Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy.
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45
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Guyton RA, Block PC, Thourani VH, Lerakis S, Babaliaros V. Carotid artery access for transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2013; 82:E583-6. [DOI: 10.1002/ccd.24596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 07/17/2012] [Accepted: 07/30/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Robert A. Guyton
- Division of Cardiovascular Surgery and Division of Cardiology; Emory University Hospitals; Emory University School of Medicine; Atlanta; GA
| | - Peter C. Block
- Division of Cardiovascular Surgery and Division of Cardiology; Emory University Hospitals; Emory University School of Medicine; Atlanta; GA
| | - Vinod H. Thourani
- Division of Cardiovascular Surgery and Division of Cardiology; Emory University Hospitals; Emory University School of Medicine; Atlanta; GA
| | - Stamatios Lerakis
- Division of Cardiovascular Surgery and Division of Cardiology; Emory University Hospitals; Emory University School of Medicine; Atlanta; GA
| | - Vasilis Babaliaros
- Division of Cardiovascular Surgery and Division of Cardiology; Emory University Hospitals; Emory University School of Medicine; Atlanta; GA
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46
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47
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Magalhães MA, Souza JM, Grube E. Transcatheter aortic valve implantation through a diseased left common carotid artery: Combined approach with endarterectomy and left carotid-subclavian bypass. Catheter Cardiovasc Interv 2013; 81:618-22. [DOI: 10.1002/ccd.24588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/01/2012] [Accepted: 07/30/2012] [Indexed: 01/24/2023]
Affiliation(s)
- Marco A. Magalhães
- Department of Cardiology; Hospital Alemão Oswaldo Cruz; São Paulo; Brazil
| | - Januário M. Souza
- Department of Cardiology; Hospital Alemão Oswaldo Cruz; São Paulo; Brazil
| | - Eberhard Grube
- Department of Cardiology; Hospital Alemão Oswaldo Cruz; São Paulo; Brazil
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48
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Right subclavian approach in transcatheter aortic valve implantation using the CoreValve prosthesis. COR ET VASA 2012. [DOI: 10.1016/j.crvasa.2012.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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49
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Roselli EE. Invited commentary. Ann Thorac Surg 2012; 93:1494-5. [PMID: 22541181 DOI: 10.1016/j.athoracsur.2012.02.038] [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: 02/09/2012] [Revised: 02/09/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Eric E Roselli
- Cleveland Clinic Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, 9500 Euclid Ave, Desk J4-1, Cleveland, OH 44195, USA.
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