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Jabri A, Alameh A, Giustino G, Gonzalez PE, O’Neill B, Bagur R, Cox P, Frisoli T, Lee J, Wang DD, O’Neill WW, Villablanca P. Transcatheter Aortic Valve Replacement is Ready for Most Low-risk Patients: A Systematic Review of the Literature. Card Fail Rev 2024; 10:e11. [PMID: 39386082 PMCID: PMC11462515 DOI: 10.15420/cfr.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/26/2024] [Indexed: 10/12/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has undergone rapid expansion, emerging as a viable therapeutic option for low-risk patients in lieu of surgical aortic valve replacement. This paper aims to provide a review of the scientific evidence concerning TAVR in low-risk patients, encompassing both observational and clinical trial data. Furthermore, a substantial proportion of low-risk patients possesses a bicuspid aortic valve, necessitating careful examination of the pertinent anatomic and clinical considerations to TAVR that is highlighted in this review. Additionally, the review expands upon some of the unique challenges associated with alternate access in low-risk patients evaluated for TAVR. Last, this review outlines the pivotal role of a multidisciplinary heart team approach in the execution of all TAVR procedures and the authors' vision of 'minimalist TAVR' as a new era in low-risk TAVR.
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Affiliation(s)
- Ahmad Jabri
- Division of Cardiology, Structural Heart Disease Center, Henry Ford HospitalDetroit, MI, US
| | - Anas Alameh
- Division of Cardiology, Structural Heart Disease Center, Henry Ford HospitalDetroit, MI, US
| | - Gennaro Giustino
- Division of Cardiology, Structural Heart Disease Center, Henry Ford HospitalDetroit, MI, US
| | - Pedro Engel Gonzalez
- Division of Cardiology, Structural Heart Disease Center, Henry Ford HospitalDetroit, MI, US
| | - Brian O’Neill
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western UniversityLondon, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western UniversityLondon, Ontario, Canada
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western UniversityLondon, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western UniversityLondon, Ontario, Canada
| | - Pedro Cox
- Division of Cardiology, Department of Medicine, Louisiana State UniversityNew Orleans, LA, US
| | - Tiberio Frisoli
- Division of Cardiology, Structural Heart Disease Center, Henry Ford HospitalDetroit, MI, US
| | - James Lee
- Division of Cardiology, Structural Heart Disease Center, Henry Ford HospitalDetroit, MI, US
| | - Dee Dee Wang
- Division of Cardiology, Structural Heart Disease Center, Henry Ford HospitalDetroit, MI, US
| | - William W O’Neill
- Division of Cardiology, Structural Heart Disease Center, Henry Ford HospitalDetroit, MI, US
| | - Pedro Villablanca
- Division of Cardiology, Structural Heart Disease Center, Henry Ford HospitalDetroit, MI, US
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Jehl C, Sanchez S, Chapoutot L, Tassan Mangina S, Heroguelle V, Villecourt A, Metz D, Faroux L. [Local versus locoregional anesthesia in transfemoral TAVI procedures]. Ann Cardiol Angeiol (Paris) 2024; 73:101786. [PMID: 39126902 DOI: 10.1016/j.ancard.2024.101786] [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: 06/07/2024] [Accepted: 07/02/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) has become the treatment of choice for the most fragile patients with severe aortic stenosis. The transfemoral route is preferred as the simplest and safest. The aim of our study was to compare the efficacy, tolerance and safety of local vs. locoregional anesthesia in trans-femoral TAVI procedures. MATERIAL AND METHOD This was a single-center retrospective study. Patients treated with femoral TAVI between February 25 and November 15, 2022 at the University Hospital of Reims were included, and two groups (local and locoregional anesthesia) were compared. RESULTS TAVI success rate (92.9%), death rate (3.0%) and procedure duration (90.5 ± 13.5 minutes) did not differ between groups (p = 0.18, 0.15 and 0.55 respectively). For intra- and post-procedural treatments, the use of sedation, analgesics and benzodiazepines did not differ between groups. The cumulative dose of Remifentanil used per-procedure was lower in the local anesthesia group than in the locoregional anesthesia group (148.6 ± 71.9 mcg vs. 208.9 ± 110.0 mcg; p = 0.025). CONCLUSIONS In this non-randomized retrospective study, local and locoregional anesthesia had comparable safety and efficacy in transfemoral TAVI procedures. In a constrained context and with a view to simplification, these results encourage transfemoral TAVIs to be performed under local anaesthesia, and to consider a "PCI-like" approach, without the presence of an anaesthetist, for selected patients without respiratory, musculoskeletal or agitation disorders, or vascular approach difficulties.
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Affiliation(s)
- Clément Jehl
- Service de cardiologie, Centre Hospitalier de Troyes, 101 avenue Anatole France, 10000 Troyes, France; Service de cardiologie, Centre Hospitalo-Universitaire de Reims, 51 avenue Cognacq Jay, 51100 Reims, France.
| | - Stéphane Sanchez
- Pôle Santé Publique et Performance, Hôpitaux Champagne Sud, 101 avenue Anatole France, 10000 Troyes, France.
| | - Laurent Chapoutot
- Service de cardiologie, Centre Hospitalier de Troyes, 101 avenue Anatole France, 10000 Troyes, France.
| | - Sophie Tassan Mangina
- Service de cardiologie, Centre Hospitalo-Universitaire de Reims, 51 avenue Cognacq Jay, 51100 Reims, France.
| | - Virginie Heroguelle
- Service de cardiologie, Centre Hospitalo-Universitaire de Reims, 51 avenue Cognacq Jay, 51100 Reims, France.
| | - Aurelien Villecourt
- Service de cardiologie, Centre Hospitalo-Universitaire de Reims, 51 avenue Cognacq Jay, 51100 Reims, France.
| | - Damien Metz
- Service de cardiologie, Centre Hospitalo-Universitaire de Reims, 51 avenue Cognacq Jay, 51100 Reims, France.
| | - Laurent Faroux
- Service de cardiologie, Centre Hospitalo-Universitaire de Reims, 51 avenue Cognacq Jay, 51100 Reims, France.
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Purmessur R, Ahmed Z, Ali J. Exploring Optimal Strategies for Surgical Access in Transcatheter Aortic Valve Implantation. J Clin Med 2024; 13:4655. [PMID: 39200796 PMCID: PMC11354912 DOI: 10.3390/jcm13164655] [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: 06/22/2024] [Revised: 07/23/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionised the management of severe aortic stenosis, particularly for patients deemed high risk or inoperable for traditional surgical aortic valve replacement. The transfemoral approach is the preferred route whenever feasible, attributed to its minimally invasive nature, reduced procedural morbidity, and shorter recovery times. In total, 80-90% of TAVI procedures are performed via the transfemoral route. However, anatomical constraints such as severe peripheral arterial disease, small vessel diameter, or significant vessel tortuosity can preclude the use of this access site. In such cases, alternative access strategies must be considered to ensure the successful implantation of the valve. This review aims to provide a comprehensive summary of the various surgical techniques available for TAVI access, exploring the rationale, technical aspects, and challenges associated with each method. We will explore alternative routes, including the transapical, transaortic, transaxillary, and transcarotid approaches, highlighting their respective benefits and limitations.
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Affiliation(s)
- Rushmi Purmessur
- Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK;
| | - Zeba Ahmed
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Jason Ali
- Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK;
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Fong KY, Yap JJL, Chan YH, Ewe SH, Chao VTT, Amanullah MR, Govindasamy SP, Aziz ZA, Tan VH, Ho KW. Network Meta-Analysis Comparing Transcatheter, Minimally Invasive, and Conventional Surgical Aortic Valve Replacement. Am J Cardiol 2023; 195:45-56. [PMID: 37011554 DOI: 10.1016/j.amjcard.2023.02.017] [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: 12/13/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Abstract
The landscape of aortic valve replacement (AVR) has evolved dramatically over the years, but time-varying outcomes have yet to be comprehensively explored. This study aimed to compare the all-cause mortality among 3 AVR techniques: transcatheter (TAVI), minimally invasive (MIAVR), and conventional AVR (CAVR). An electronic literature search was performed for randomized controlled trials (RCTs) comparing TAVI with CAVR and RCTs or propensity score-matched (PSM) studies comparing MIAVR with CAVR or MIAVR to TAVI. Individual patient data for all-cause mortality were derived from graphical reconstruction of Kaplan-Meier curves. Pairwise comparisons and network meta-analysis were conducted. Sensitivity analyses were performed in the TAVI arm for high risk and low/intermediate risk, as well as patients who underwent transfemoral (TF) TAVI. A total of 27 studies with 16,554 patients were included. In the pairwise comparisons, TAVI showed superior mortality to CAVR until 37.5 months, beyond which there was no significant difference. When restricted to TF TAVI versus CAVR, a consistent mortality benefit favoring TF TAVI was seen (shared frailty hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.76 to 0.98, p = 0.024). In the network meta-analysis involving majority PSM data, MIAVR demonstrated significantly lower mortality than TAVI (HR = 0.70, 95% CI = 0.59 to 0.82) and CAVR (HR = 0.69, 95% CI = 0.59 to 0.80); this association remained compared with TF TAVI but with a lower extent of benefit (HR = 0.80, 95% CI = 0.65 to 0.99). In conclusion, the initial short- to medium-term mortality benefit for TAVI over CAVR was attenuated over the longer term. In the subset of patients who underwent TF TAVI, a consistent benefit was found. Among majority PSM data, MIAVR showed improved mortality compared with TAVI and CAVR but less than the TF TAVI subset, which requires validation by robust RCTs.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Victor T T Chao
- Department of Cardiothoracic Surgery, National Heart Center Singapore, Singapore
| | | | | | - Zameer Abdul Aziz
- Department of Cardiothoracic Surgery, National Heart Center Singapore, Singapore
| | - Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, Singapore
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Tezuka T, Higuchi R, Hagiya K, Saji M, Takamisawa I, Nanasato M, Iguchi N, Shimizu A, Shimizu J, Doi S, Okazaki S, Sato K, Tamura H, Yokoyama H, Onishi T, Tobaru T, Takanashi S, Takayama M. Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry. JACC. ASIA 2023; 3:78-89. [PMID: 36873767 PMCID: PMC9982279 DOI: 10.1016/j.jacasi.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 12/15/2022]
Abstract
Background Obesity is a major risk factor for cardiovascular disease; however, a paradoxical effect of obesity has been reported in patients with heart failure or myocardial infarction. Although several studies have suggested the same obesity paradox in patients undergoing transcatheter aortic valve replacement (TAVR), they included a limited number of underweight patients. Objectives This study aimed to clarify the effect of being underweight on TAVR outcomes. Methods We retrospectively analyzed 1,693 consecutive patients undergoing TAVR between 2010 and 2020. The patients were categorized according to body mass index: underweight (<18.5 kg/m2; n = 242), normal weight (18.5 to 25 kg/m2; n = 1,055), and overweight (>25 kg/m2; n = 396). We compared midterm outcomes after TAVR among the 3 groups; all clinical events were in accordance with the Valve Academic Research Consortium-2 criteria. Results Underweight patients were more likely to be women and have severe heart failure symptoms, peripheral artery disease, anemia, hypoalbuminemia, and pulmonary dysfunction. They also had lower ejection fractions, smaller aortic valve areas, and higher surgical risk scores. Device failure, life-threatening bleeding, major vascular complications, and 30-day mortality occurred more frequently in underweight patients. The midterm survival rate of the underweight group was inferior to those of the other 2 groups (P < 0.0001; average follow-up, 717 days). In the multivariate analysis, underweight was associated with noncardiovascular mortality (HR: 1.78; 95% CI: 1.16-2.75) but not cardiovascular mortality (HR: 1.28; 95% CI: 0.58-1.88) after TAVR. Conclusions Underweight patients had a worse midterm prognosis, demonstrating the obesity paradox in this TAVR population. (Outcomes of transcatheter aortic valve implantation in Japanese patients with aortic stenosis: multi-center registry; UMIN000031133).
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Affiliation(s)
- Taiyo Tezuka
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Atsushi Shimizu
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Sato
- Department of Cardiology, Mie University Hospital, Mie, Japan
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University Hospital, Yamagata, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Takayuki Onishi
- Department of Cardiology, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.,Department of Cardiac Surgery, Kawasaki Saiwai Hospital, Kanagawa, Japan
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Ismayl M, Machanahalli Balakrishna A, Fahmy MM, Thandra A, Gill GS, Niu F, Agarwal H, Aboeata A, Goldsweig AM, Smer A. Impact of sex on in-hospital mortality and 90-day readmissions in patients undergoing transcatheter mitral valve replacement (TMVR): Analysis from the nationwide readmission database. Catheter Cardiovasc Interv 2023; 101:407-416. [PMID: 36617383 DOI: 10.1002/ccd.30549] [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: 02/14/2022] [Revised: 08/13/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To evaluate sex differences in in-hospital mortality and 90-day readmission rates among patients undergoing transcatheter mitral valve replacement (TMVR) in the United States of America. BACKGROUND Women have higher rates of mortality and rehospitalization than men following many cardiac procedures. TMVR has grown as an alternative to mitral valve surgery for patients at high surgical risk. The rates of TMVR mortality and rehospitalization by sex are unknown. METHODS We analyzed the Nationwide Readmissions Database (NRD) from 2016 to 2019 to identify hospitalizations for TMVR. Sex differences in in-hospital mortality and 90-day readmissions were determined using logistic regression models. RESULTS Between 2016 and 2019, 4109 hospitalizations for TMVR were identified, comprised of 1758 (42.8%) men and 2351 (57.2%) women. The median age was 74 years for both men and women. There was no significant difference in in-hospital mortality during index hospitalization (6.51% vs. 6.69%; p = 0.852) and all-cause 90-day readmission (28.19% vs. 29.59%; p = 0.563) between men and women. Across the study period, trend analysis did not reveal a significant change in in-hospital mortality (men p = 0.087, women p = 0.194) or 90-day readmission rates (men p = 0.569, women p = 0.454). CONCLUSIONS In patients undergoing TMVR, in-hospital mortality and 90-day readmissions are similar between men and women. Between 2016 and 2019, TMVR in-hospital mortality and 90-day readmission rates remained unchanged. Further research is necessary to confirm these findings.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | | | - Mostafa Mahmoud Fahmy
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Abhishek Thandra
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Gauravpal S Gill
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Fang Niu
- Department of Medicine, Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Himanshu Agarwal
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Ahmed Aboeata
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andrew M Goldsweig
- Department of Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Aiman Smer
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
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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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Hardisky D, Vijayakumar A, Whitson BA, Lilly SM, Boudoulas KD, Vallely MP. Concomitant anaortic OPCAB and transfemoral TAVR for high-risk patients: A case series. J Card Surg 2022; 37:3935-3942. [PMID: 36098378 DOI: 10.1111/jocs.16838] [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: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Combined on-pump coronary artery bypass (ONCAB) and surgical aortic valve replacement (SAVR) is the treatment of choice for concomitant severe aortic stenosis and coronary artery disease not amenable to percutaneous coronary intervention. Extensive aortic calcification and atheromatous disease may prohibit cardiopulmonary bypass and aortic cross-clamping. In these cases, anaortic off-pump coronary artery bypass (OPCAB) is a Class I (EACTS 2018) and Class IIA (AHA 2021) indication for surgical coronary revascularization. Transcatheter aortic valve replacement (TAVR) has similar benefits when compared with SAVR for this population (Partner 2 & 3). Herewith we describe a case series of concomitant Anaortic OPCAB and TAVR via the transfemoral approach for patients with coronary artery and valve disease considered too high risk for traditional coronary artery bypass grafting and SAVR due to severe aortic disease. METHODS/RESULTS Eight patients underwent anaortic OPCAB and transfemoral TAVR during the same anesthetic in a hybrid operating room. Seven patients with multivessel disease had anaortic OPCAB via a sternotomy using composite grafts, one patient with LAD disease had anaortic OPCAB using a Da Vinci-assisted MIDCAB approach. All patients then had an Edwards Sapien 3 TAVR placed percutaneously via the common femoral artery. There was no 30 mortality or CVA in the series and all patients were discharged to home or a rehabilitation facility on Day 4-13. CONCLUSIONS Combined anaortic OPCAB and transfemoral TAVR is a safe and feasible approach to treating concomitant extensive coronary artery disease and severe aortic stenosis. The aortic no-touch technique provides benefits in the elderly high-risk patients by reducing the risk of postoperative myocardial infarction and cerebrovascular stroke.
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Affiliation(s)
- Dariya Hardisky
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ammu Vijayakumar
- Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bryan A Whitson
- Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Scott M Lilly
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - K Dean Boudoulas
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael P Vallely
- Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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9
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Tomala O, Zamvar V, Bing R, Pessotto R, Cruden N. Comparison of outcomes of trans-subclavian versus trans-apical approaches in transcatheter aortic valve implantation. J Cardiothorac Surg 2022; 17:180. [PMID: 35927712 PMCID: PMC9354363 DOI: 10.1186/s13019-022-01929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background Many patients are unsuitable for conventional femoral transcatheter aortic valve implantation (TAVI) but there is limited evidence as to which alternative approach has the best outcomes. We compared clinical outcomes in patients undergoing trans-subclavian (TS) or trans-apical (TA) TAVI. Methods This was a national retrospective observational study of patients undergoing surgical TAVI in Scotland between January 2013 and March 2020. The pre-operative patient characteristics, intraoperative details and post-operative outcomes were compared between TS and TA cohorts using data from the National Institute of Cardiovascular Outcomes Research (NICOR) registry. Results Among 1055 patients who underwent TAVI, TS or TA access was used in 50 (4.7%) and 90 (8.5%) patients respectively. Self-expanding Medtronic Evolut R valves were used in 84% of TS procedures, while balloon-expandable Edwards SAPIEN valves were used in all TA procedures. The TS group had a lower mean logistic EuroSCORE than the TA group (27.31 ± 19.44% vs 34.92 ± 19.61% p = 0.029). The TS approach was associated with a higher incidence of moderate postprocedural aortic regurgitation (12.5% vs 2.4%, p = 0.025). There was no significant difference in 30-day, 1-year or overall all-cause mortality. Conclusions Both trans-subclavian and trans-apical access are viable approaches for patients requiring non-transfemoral TAVI. Differences in peri-procedural indices reflect the disparate patient populations and factors governing prosthesis choice, and short- and long-term mortality was similar.
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Affiliation(s)
- Olaf Tomala
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Vipin Zamvar
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
| | - Rong Bing
- Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Renzo Pessotto
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Nick Cruden
- Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
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10
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Hameed I, Khan MO, Ul-Haque I, Siddiqui OM, Samad SA, Malik S, Mahmood S. Transaxillary Versus Transaortic Transcatheter Aortic Valve Implantation in the Treatment of Aortic Stenosis: An Updated Systematic Review and Meta-Analysis. Cureus 2022; 14:e24054. [PMID: 35573526 PMCID: PMC9097931 DOI: 10.7759/cureus.24054] [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] [Accepted: 04/12/2022] [Indexed: 11/05/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a technique that can be performed through multiple approaches, and the benefits of one approach over another are still being evaluated to make sure patients receive the best possible care. Our meta-analysis aims to compare clinical and procedural outcomes of the transaxillary (TAx) and transaortic (TAo) approaches to validate the more optimal procedure. The systematic literature search was done via PubMed/MEDLINE, Embase, and the Cochrane Central databases from inception to December 2021, to identify articles reporting data on both TAx TAVR and TAo TAVR. In addition, we checked ClinicalTrials.gov for more published or unpublished trials. Baseline patient characteristics, procedure results, and clinical results were extracted from the article and pooled for analysis. A quantitative meta-analysis was conducted using Review Manager (RevMan) version 5.3 (Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). The outcomes extracted included blood transfusion, conversion to sternotomy, tamponade, contrast amount, procedure time, bleeding incidents (minor, major, or life-threatening), length of stay (LOS), vascular complications (minor or major), acute kidney injury (AKI), paravalvular leak (PVL), permanent pacemaker (PPM) implantation, 30-day mortality, one-year mortality, 30-day stroke, and device success. The final analysis included 11 articles, consisting of 10 observational studies and a pivotal trial. Cumulative results revealed that the TAo approach had a significantly lower incidence of vascular complications (RR = 2.30; 95% CI = 1.22 to 4.35), and the need for implantation of a permanent pacemaker (RR = 1.82; 95% CI = 1.30 to 2.54) along with a lower amount of contrast (mean difference (MD) = 27.40; 95% CI = 3.73 to 51.08) needed to be used. The TAx group was associated with a significantly lower 30-day mortality (RR = 0.46; 95% CI = 0.31 to 0.69), AKI (RR = 0.47; 95% CI = 0.33 to 0.67), and length of hospital stay (MD = −1.95; 95% CI = −2.51 to −1.38). No significant difference was observed between the outcomes of 30-day stroke (RR = 1.38; 95% CI = 0.81 to 2.33), PVL (RR = 1.05; 95% CI = 0.50 to 2.18), tamponade (RR = 0.71; 95% CI = 0.12 to 4.03), conversion to sternotomy (RR = 0.51; 95% CI = 0.06 to 4.30), device success (RR = 0.97; 95% CI = 0.88 to 1.07), the incidence of bleeding (RR = 0.75; 95% CI = 0.51 to 1.10), and procedure time (MD = 4.44; 95% CI = −96.30 to 105.17). Both the procedures were associated with their benefits and risks. Although most of the outcomes favored TAx transcatheter aortic valve implantation (TAVI), it is too early to say if it would be better than TAo TAVI. To authenticate the findings concluded in this meta-analysis and further improve our understanding of the efficacy, safety, and risk profile between TAx and TAo approaches for TAVI, large sample randomized clinical trials are required on a wide scale.
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11
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Stastny L, Krapf C, Dumfarth J, Gasser S, Bauer A, Friedrich G, Metzler B, Feuchtner G, Mayr A, Grimm M, Bonaros N. Minireview: Transaortic Transcatheter Aortic Valve Implantation: Is There Still an Indication? Front Cardiovasc Med 2022; 9:798154. [PMID: 35310977 PMCID: PMC8931192 DOI: 10.3389/fcvm.2022.798154] [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: 10/19/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Transaortic (TAo) transcatheter aortic valve implantation has become a valid alternative access route in patients with unsuitable femoral arteries. The current literature does not allow to clearly favor one of the alternative access routes. Every approach has its specific advantages. Transaortic (TAo) access is of particular importance in the case of calcifications of the supra-aortic branches and the aortic arch, as under these circumstances other alternative access routes, such as transaxillary or transcarotid, are not feasible. The purpose of this minireview is to give an overview and update on TAo transcatheter aortic valve implantation focusing on indication, technical aspects, and recent clinical data.
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Affiliation(s)
- Lukas Stastny
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Krapf
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
- *Correspondence: Julia Dumfarth
| | - Simone Gasser
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Guy Friedrich
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Metzler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
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12
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Cerillo AG, Pennesi M, Iannone L, Giustini G, de Cillis P, Valenti R, Marchionni N, Stefano P. Case Report: Lithoplasty-Assisted Trans-Axillary Transcatheter Aortic Valve-in-Valve Implantation. Front Cardiovasc Med 2021; 8:747588. [PMID: 34746261 PMCID: PMC8564067 DOI: 10.3389/fcvm.2021.747588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
We present the case of a severely symptomatic patient with a malfunctioning aortic bioprosthesis and severe multidistrict atherosclerosis that was addressed to our unit for transcatheter valve-in-valve implantation. The imaging and clinical assessment that led to the selection of the access route is discussed.
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Affiliation(s)
| | - Matteo Pennesi
- Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Luisa Iannone
- Unit of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Giorgia Giustini
- Unit of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Paolo de Cillis
- Unit of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Renato Valenti
- Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- General Cardiology, Careggi University Hospital, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence School of Medicine, Florence, Italy
| | - Pierluigi Stefano
- Unit of Cardiac Surgery, Careggi University Hospital, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence School of Medicine, Florence, Italy
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13
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Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project. J Cardiovasc Dev Dis 2021; 8:jcdd8090114. [PMID: 34564131 PMCID: PMC8472227 DOI: 10.3390/jcdd8090114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort. Methods: All-comer aortic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019. The primary endpoint was 1-year mortality. We also investigated 3-year mortality, and ischemic and hemorrhagic endpoints, and we performed a propensity score matching to assemble patients with similar baseline characteristics. Results: Out of 3821 patients, 2149 (56.2%) women were enrolled. Compared with men, women were older (83 ± 6 vs. 81 ± 6 years, p < 0.001), more likely to present severe renal impairment (GFR ≤ 30 mL/min, 26.3% vs. 16.3%, p < 0.001) but had less previous cardiovascular events (all p < 0.001), with a higher mean Society of Thoracic Surgeons (STS) score (7.8% ± 7.1% vs. 7.2 ± 7.5, p < 0.001) and a greater mean aortic gradient (52.4 ± 15.3 vs. 47.3 ± 12.8 mmHg, p < 0.001). Transfemoral TAVR was performed more frequently in women (87.2% vs. 82.1%, p < 0.001), with a higher rate of major vascular complications and life-threatening bleeding (3.9% vs. 2.4%, p = 0.012 and 2.5% vs. 1.4%, p = 0.024). One-year mortality differed between female and male (11.5% vs. 15.0%, p = 0.002), and this difference persisted after adjustment for significant confounding variables (Adj.HR1yr 1.47, 95%IC 1.18–1.82, p < 0.001). Three-year mortality was also significantly lower in women compared with men (19.8% vs. 24.9%, p < 0.001) even after adjustment for age, STS score, eGFR, diabetes and severe COPD (Adj.HR3yr 1.42, 95%IC 1.21–1.68, p < 0.001). These results were confirmed in 689 pairs after propensity score matching. Conclusion: Despite higher rates of peri-procedural complications, women presented better survival than men. This better adaptive response to TAVR may be driven by sex-specific factors.
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14
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Hameed I, Oakley CT, Hameed NUF, Ahmed A, Naeem N, Singh S, Rizwana K, Brackett A, Forrest JK, Kaple R, Mangi A, Salemi A, Geirsson A, Gaudino M, Vallabhajosyula P. Alternate accesses for transcatheter aortic valve replacement: A network meta-analysis. J Card Surg 2021; 36:4308-4319. [PMID: 34494307 DOI: 10.1111/jocs.15961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND When transfemoral (TF) access is contraindicated in patients undergoing transcatheter aortic valve replacement (TAVR), alternate access strategies are considered. The choice of one alternate access over the other remains controversial. METHODS Following a comprehensive literature search, studies comparing any combination of TF, transapical (TA), transaortic (TAo), transcarotid (TC), and trans-subclavian (TS) TAVR were identified. Data were pooled using fixed- and random-effects network meta-analysis. Rank scores with probability ranks of different treatment groups were calculated. RESULTS Eighty-four studies (26,449 patients) were included. Compared to TF access, TA and TAo accesses were associated with higher 30-day mortality (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.31-1.94; OR 1.79, 95% CI 1.21-2.66, respectively), while the TC and TS showed no difference (OR 1.12, 95% CI 0.64-1.95; OR 1.23, 95% CI 0.67-2.27, respectively); TF access ranked best followed by TC. There was no significant difference in 30-day stroke; TC access ranked best followed by TS. At a weighted mean follow-up of 1.6 years, TA and TAo accesses were associated with higher long-term mortality versus TF (incidence rate ratio [IRR] 1.31, 95% CI 1.18-1.45; IRR 1.41, 95% CI 1.11-1.79, respectively); there was no difference between TC and TS versus TF access (IRR 1.02, 95% CI 0.70-1.47; IRR 1.16, 95% CI 0.82-1.66, respectively); TF access ranked best followed by TC. At a weighted mean follow-up of 1.4 years, only TA access was associated with higher long-term stroke compared to TF (IRR 3.01, 95% CI 1.15-7.87); TF access ranked as the best strategy followed by TAo. CONCLUSION TC and TS approaches are associated with superior postoperative outcomes compared to other TAVR alternate access strategies. Randomized trials definitively assessing the safety and efficacy of alternate access strategies are needed.
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Affiliation(s)
- Irbaz Hameed
- Department of Surgery, Section of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christian T Oakley
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - N U Farrukh Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Adham Ahmed
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Nyla Naeem
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Saket Singh
- Department of Surgery, Section of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kaniz Rizwana
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Alexandria Brackett
- Cushing/Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - John K Forrest
- Department of Internal Medicine, Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ryan Kaple
- Department of Internal Medicine, Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Abeel Mangi
- Department of Surgery, Section of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arash Salemi
- Department of Cardiothoracic Surgery, Robert Wood Johnson/Barnabas Health, West Orange, New Jersey, USA
| | - Arnar Geirsson
- Department of Surgery, Section of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Prashanth Vallabhajosyula
- Department of Surgery, Section of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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15
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Morozowich ST, Sell-Dottin KA, Crestanello JA, Ramakrishna H. Transcarotid Versus Transaxillary/Subclavian Transcatheter Aortic Valve Replacement (TAVR): Analysis of Outcomes. J Cardiothorac Vasc Anesth 2021; 36:1771-1776. [PMID: 34083097 DOI: 10.1053/j.jvca.2021.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/11/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the percutaneous management of valvular heart disease and has evolved to progressively minimalist techniques over the past decade. This review discusses the impact of minimalist TAVR, explores the alternative approaches when transfemoral (TF) TAVR is not possible, and analyzes the current outcomes of transcarotid (TC) versus transaxillary/subclavian (TAx) TAVR, which are the two leading nonfemoral (NF) approaches emerging as the preferred alternatives to TF TAVR.
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Affiliation(s)
- Steven T Morozowich
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ
| | | | | | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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16
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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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17
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Morris JP, Cadogan D, Casserly IP. Intravascular lithotripsy-assisted balloon angioplasty to facilitate transfemoral transcatheter aortic valve implantation in a patient with coral reef aorta. BMJ Case Rep 2021; 14:e240876. [PMID: 33758050 PMCID: PMC7993158 DOI: 10.1136/bcr-2020-240876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/03/2022] Open
Abstract
This case describes the management of a woman in her 70s with severe symptomatic aortic stenosis and concomitant severe stenosis of the suprarenal abdominal aorta due to 'coral reef' calcification of the aortic wall and lumen (CRA). Due to her religious beliefs as a Jehovah's Witness regarding the use of blood products, she rejected the option of surgical aortic valve replacement. Transfemoral (TF) delivery of a transcatheter aortic valve was challenged by the presence of CRA. A successful TF transcatheter aortic valve implantation (TAVI) was achieved by the treatment of the CRA with intravascular lithotripsy-assisted angioplasty, followed by delivery and deployment of a self-expanding TAVI valve.
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Affiliation(s)
| | - Diarmaid Cadogan
- Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ivan P Casserly
- Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
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18
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Brener MI, George I, Kosmidou I, Nazif T, Zhang Z, Dizon JM, Garan H, Malaisrie SC, Makkar R, Mack M, Szeto WY, Fearon WF, Thourani VH, Leon MB, Kodali S, Biviano AB. Atrial Fibrillation Is Associated With Mortality in Intermediate Surgical Risk Patients With Severe Aortic Stenosis: Analyses From the PARTNER 2A and PARTNER S3i Trials. J Am Heart Assoc 2021; 10:e019584. [PMID: 33754803 PMCID: PMC8174321 DOI: 10.1161/jaha.120.019584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The impact of atrial fibrillation (AF) in intermediate surgical risk patients with severe aortic stenosis who undergo either transcatheter or surgical aortic valve replacement (AVR) is not well established. Methods and Results Data were assessed in 2663 patients from the PARTNER (Placement of Aortic Transcatheter Valve) 2A or S3i trials. Analyses grouped patients into 3 categories according to their baseline and discharge rhythms (ie, sinus rhythm [SR]/SR, SR/AF, or AF/AF). Among patients with transcatheter AVR (n=1867), 79.2% had SR/SR, 17.6% had AF/AF, and 3.2% had SR/AF. Among patients with surgical AVR (n=796), 71.7% had SR/SR, 14.1% had AF/AF, and 14.2% had SR/AF. Patients with transcatheter AVR in AF at discharge had increased 2-year mortality (SR/AF versus SR/SR; hazard ratio [HR], 2.73; 95% CI, 1.68-4.44; P<0.0001; AF/AF versus SR/SR; HR, 1.56; 95% CI, 1.16-2.09; P=0.003); patients with SR/AF also experienced increased 2-year mortality relative to patients with AF/AF (HR, 1.77; 95% CI, 1.04-3.00; P=0.03). For patients with surgicalAVR, the presence of AF at discharge was also associated with increased 2-year mortality (SR/AF versus SR/SR; HR, 1.93; 95% CI, 1.25-2.96; P=0.002; and AF/AF versus SR/SR; HR, 1.67; 95% CI, 1.06-2.63; P=0.027). Rehospitalization and persistent advanced heart failure symptoms were also more common among patients with transcatheter AVR and surgical AVR discharged in AF, and major bleeding was more common in the transcatheter AVR cohort. Conclusions The presence of AF at discharge in patients with intermediate surgical risk aortic stenosis was associated with worse outcomes-especially in patients with baseline SR-including increased all-cause mortality at 2-year follow-up. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01314313 and NCT03222128.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Isaac George
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Ioanna Kosmidou
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY.,Cardiovascular Research Foundation New York NY
| | - Tamim Nazif
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | | | - Jose M Dizon
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Hasan Garan
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | | | - Raj Makkar
- Cedars-Sinai Medical Center Los Angeles CA
| | | | | | | | | | - Martin B Leon
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY.,Cardiovascular Research Foundation New York NY
| | - Susheel Kodali
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Angelo B Biviano
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
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19
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Jones BM, Kumar V, Chiu ST, Korngold E, Hodson RW, Spinelli KJ, Kirker EB. Comparable Outcomes for Transcarotid and Transfemoral Transcatheter Aortic Valve Replacement at a High Volume US Center. Semin Thorac Cardiovasc Surg 2021; 34:467-474. [PMID: 33713830 DOI: 10.1053/j.semtcvs.2021.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/11/2022]
Abstract
With continued growth of transcatheter aortic valve replacement (TAVR), safe alternative access remains important for patients without adequate transfemoral (TF) access. Registry-based outcomes with transcarotid (TC) TAVR are favorable compared to transapical or transaxillary/subclavian, but TC vs TF comparisons have not been made. Our objective was to compare outcomes between TF and TC access routes for TAVR at a high-volume United States center. Methods: We retrospectively evaluated all TF and TC TAVR procedures from June 11, 2014 (first TC case) through December 31, 2019. The primary outcomes were 30-day stroke and 30-day mortality. Secondary outcomes were 1-year stroke, 1-year survival, and 30-day and 1-year life-threatening/major bleeding, vascular complications, and myocardial infarction. Propensity score weighted (PSW) models were used to compare risk-adjusted TF and TC outcomes. Of 1,465 TAVR procedures, 1319 (90%) were TF and 146 (10%) were TC. Procedure time and length of stay did not differ between groups. Unadjusted 30-day stroke (TF = 2.0%, TC = 2.7%, P = 0.536) and mortality (TF = 2.1%, TC = 2.7%, P = 0.629) were similar between groups. PSW 30-day stroke (odds ratio (OR) (95% confidence interval (CI)) = 0.8 (0.2-2.8)) and mortality (OR (95% CI) = 0.8 (0.2-3.0)) were similar between groups. Unadjusted and PSW 30-day major/life threatening bleeding, major vascular complications, and myocardial infarction did not differ between groups. Survival at one year was 90% (88%-92%) for TF patients and 87% (81%-93%) for TC patients (unadjusted P = 0.28, PSW hazard ratio = 1.0 (0.6-1.7)). Transcarotid TAVR is associated with similar outcomes compared to transfemoral TAVR at an experienced, high-volume center.
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Affiliation(s)
- Brandon M Jones
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, , Portland, Oregon.
| | - Vishesh Kumar
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, , Portland, Oregon
| | - Shih Ting Chiu
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, , Portland, Oregon
| | - Ethan Korngold
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, , Portland, Oregon
| | - Robert W Hodson
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, , Portland, Oregon
| | - Kateri J Spinelli
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, , Portland, Oregon
| | - Eric B Kirker
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, , Portland, Oregon
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20
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Abstract
Femoral arterial access is the default strategy for large-bore interventional procedures, including temporary mechanical circulatory support implantation and structural heart therapies, based on superior outcomes and operator ease. In addition to patient size and comorbidities, vessel tortuosity, significant calcification, and diminutive vessel caliber all may make iliofemoral access prohibitively high risk or impossible. Given the increase of large-bore transcatheter procedures, bleeding avoidance strategies are essential and thus novel mechanisms for large-bore access have evolved. This article highlights the advantages, limitations, and practical approaches to the 2 most common percutaneous large-bore alternative access strategies: transaxillary and transcaval access.
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Affiliation(s)
- Amy E Cheney
- Department of Internal Medicine, Division of Cardiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195-6171, USA
| | - James M McCabe
- Department of Internal Medicine, Division of Cardiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195-6171, USA.
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21
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Murakami T, Takahashi Y, Nishimura S, Iwata S, Yamada T, Yoshiyama M, Shibata T. Endoconduit for Transcatheter Aortic Valve Implantation. Ann Thorac Cardiovasc Surg 2020; 26:365-368. [PMID: 29760324 PMCID: PMC7801180 DOI: 10.5761/atcs.cr.17-00204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Access challenges are sometimes encountered in patients who require transcatheter aortic valve implantation (TAVI). Transapical (TA) access is a well-established alternative, but it is more invasive than the standard transfemoral (TF) access techniques. We adopted the iliac endoconduit technique to perform TF TAVI in a patient with small-caliber, heavily calcified iliac arteries. This technique could provide an adequate access route for TAVI that is minimally invasive, even for patients with prohibitory iliac anatomy.
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Affiliation(s)
- Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Shinsuke Nishimura
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Shinichi Iwata
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Tokuhiro Yamada
- Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
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22
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Patel KV, Omar W, Gonzalez PE, Jessen ME, Huffman L, Kumbhani DJ, Bavry AA. Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR. Cardiol Ther 2020; 9:377-394. [PMID: 32875469 PMCID: PMC7584721 DOI: 10.1007/s40119-020-00198-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis (AS) over the last decade. The results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 and Evolut Low Risk trials demonstrated the safety and efficacy of TAVR in low-surgical-risk patients and led to the approval of TAVR for use across the risk spectrum. Heart teams around the world will now be faced with evaluating a deluge of younger, healthier patients with severe AS. Prior to the PARTNER 3 and Evolut Low Risk studies, this heterogenous patient population would have undergone surgical aortic valve replacement (SAVR). It is unlikely that TAVR will completely supplant SAVR for the treatment of severe AS in patients with a low surgical risk, as SAVR has excellent short- and long-term outcomes and years of durability data. In this review, we outline the critical role that SAVR will continue to play in the treatment of severe AS in the post-PARTNER 3/Evolut Low Risk era.
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Affiliation(s)
- Kunal V Patel
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Wally Omar
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Pedro Engel Gonzalez
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
| | - Lynn Huffman
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Anthony A Bavry
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA.
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23
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Muto Y, Higuchi R, Yoshihisa A, Hagiya K, Saji M, Takamisawa I, Tobaru T, Iguchi N, Takanashi S, Takayama M, Takeishi Y, Isobe M. Prevalence, Predictors, and Mid-Term Outcomes of Non-Home Discharge After Transcatheter Aortic Valve Implantation. Circ Rep 2020; 2:617-624. [PMID: 33693185 PMCID: PMC7933692 DOI: 10.1253/circrep.cr-20-0085] [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: 11/09/2022] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has been widely used as a valued alternative to surgical aortic valve replacement. In cardiovascular surgeries, discharge disposition has been widely investigated. We examined the prevalence and predictors of non-home discharge after TAVI, and the prognosis based on discharge destination. Methods and Results: We retrospectively analyzed 732 consecutive patients undergoing TAVI, and divided them into 2 groups: the home group (discharged directly home; n=678 [92.6%]) and the non-home group (n=54 [7.4%]). From baseline and procedural characteristics, peripheral artery disease (PAD; odds ratio [OR] 2.73; 95% confidence interval [CI] 1.25-5.97; P=0.012), previous stroke (OR 2.57; 95% CI 1.03-6.45; P=0.045), albumin level (OR 0.16 per 1-g/dL increase; 95% CI 0.07-0.39; P<0.001), and procedural stroke (OR 31.6; 95% CI 10.9-91.7; P<0.001) were independently associated with non-home discharge. In Kaplan-Meier analysis, the non-home group had worse survival than the home group (log-rank, P=0.001). In multivariate analysis, male sex, atrial fibrillation or atrial flutter, and low albumin concentrations were associated with all-cause mortality, but non-home discharge was not (P=0.18). Conclusions: Non-home discharge was recorded for 7.4% of patients undergoing TAVI, and was associated with PAD, nutritional status, and previous and procedural stroke. Non-home discharge reflects worse baseline characteristics, and may be a marker of mid-term outcome after TAVI.
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Affiliation(s)
- Yuuki Muto
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan.,Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
| | - Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan.,Department of Cardiology, Kawasaki Saiwai Hospital Kanagawa Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute Tokyo Japan.,Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital Kanagawa Japan
| | | | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
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24
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Transcarotid versus transthoracic access for transcatheter aortic valve replacement: A propensity-matched analysis. J Thorac Cardiovasc Surg 2020; 164:506-515. [DOI: 10.1016/j.jtcvs.2020.09.133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 01/24/2023]
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25
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Sharma SP, Chaudhary R, Ghuneim A, Harder W, David S, Choksi N, Kondur S, Kambhatla S, Kambhatla S, Kondur A. Carotid access for transcatheter aortic valve replacement: A meta‐analysis. Catheter Cardiovasc Interv 2020; 97:723-733. [DOI: 10.1002/ccd.29244] [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: 05/29/2020] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | - Rahul Chaudhary
- Division of Hospital Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Angela Ghuneim
- Department of Cardiology Garden City Hospital Garden City Michigan USA
| | - William Harder
- Department of Cardiology Garden City Hospital Garden City Michigan USA
| | - Shukri David
- Division of Cardiology Ascension Providence Hospital Southfield Michigan USA
| | - Nishit Choksi
- Department of Cardiology Garden City Hospital Garden City Michigan USA
| | - Snigdha Kondur
- Department of Cardiology Garden City Hospital Garden City Michigan USA
| | - Swathi Kambhatla
- Department of Cardiology Garden City Hospital Garden City Michigan USA
| | - Sujata Kambhatla
- Division of Internal Medicine Garden City Hospital Garden City Michigan USA
| | - Ashok Kondur
- Department of Cardiology Garden City Hospital Garden City Michigan USA
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26
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Kadoya Y, Zen K, Yaku H, Matoba S. Simultaneous transfemoral valve-in-valve transcatheter aortic valve replacement and debranching thoracic endovascular aortic repair through a tortuous and shaggy aorta: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32974430 DOI: 10.1093/ehjcr/ytaa175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/19/2020] [Accepted: 05/27/2020] [Indexed: 01/16/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) is a viable treatment option for managing aortic prosthetic valve dysfunction. Although the transfemoral approach is the most commonly used and preferred treatment strategy for TAVR, complex vascular access, such as aortic aneurysm, severe tortuosity, and shaggy aorta, is challenging. Case summary An 87-year-old man, who underwent surgical aortic valve replacement for aortic stenosis using a 21-mm Carpentier-Edwards Perimount Valve, presented with New York Heart Association functional Class III dyspnoea. He was diagnosed as having severe symptomatic structural valve deterioration of a bioprosthetic aortic valve. Computed tomography revealed a tortuous and shaggy descending aorta with a saccular aneurysm in the aortic arch. Simultaneous transfemoral valve-in-valve TAVR and Zone 2 thoracic endovascular aortic repair (TEVAR) with debranching were successfully performed using a 22-Fr 65-cm sheath. Although the patient developed paraplegia due to transient spinal cord ischaemia associated with TEVAR, he fully recovered with vasopressor therapy. Discussion To the best of our knowledge, this is the first report on simultaneous successful 'valve-in-valve' TAVR and debranching TEVAR using the transfemoral approach. This case demonstrated the feasibility of single-stage transfemoral TAVR and TEVAR in a high-risk patient with multicomponent disease.
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Affiliation(s)
- Yoshito Kadoya
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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27
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Amer MR, Mosleh W, Memon S, Joshi S, Sullivan B, Sharkawi M, Mather JF, Kiernan FJ, McMahon S, Duvall WL, McKay RG. Comparison of Benefit of Transcatheter Aortic Valve Implantation in Patients With Low Gradient Versus High Gradient Aortic Stenosis and Left Ventricular Dysfunction. Am J Cardiol 2020; 125:1543-1549. [PMID: 32273053 DOI: 10.1016/j.amjcard.2020.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
Patients with low gradient severe aortic stenosis (LG-AS) often exhibit significant limitations in functional status and quality of life. We aimed to evaluate the clinical effect of transcatheter aortic valve implantation (TAVI) on LG-AS patients compared to those with high transvalvular gradients and similar left ventricular dysfunction. Retrospective analysis of records for all patients with a left ventricular ejection fraction <50% who underwent TAVI at our institution was performed. Patients were grouped according to their transvalvular gradient. Data were collected from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Clinical benefit endpoints included improvements in left ventricular ejection fraction and changes in the Kansas City Cardiomyopathy Questionnaire. Additional outcomes analyzed included 1-year all-cause mortality, stroke rates, rates of rehospitalization, need for a permanent pacemaker, and hospital length of stay. Two hundred three patients met our inclusion criteria. one hundred one LG-AS patients (mean transvalvular gradient <40 mm Hg) were compared to 102 patients with high transvalvular gradients (mean transvalvular gradient >40 mm Hg). LG-AS patients yielded similar improvements in left ventricular ejection fraction (43.5% ± 63.7 vs 37.7% ± 58.7; p = 0.525) and Kansas City Cardiomyopathy Questionnaire scores (423.51% ± 1257.02 vs 266.56% ± 822.81; p = 0.352). There were no differences between the groups with respect to 1-year mortality (16.8% vs 12.7%; p = 0.412), stroke rates, hospital length of stay, need for permanent pacemaker implantation or hospital readmissions. In conclusion, we found that TAVI is associated with comparable improvement in clinical and echocardiographic outcomes in LG-AS patients as compared to those with high gradient severe aortic stenosis.
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Affiliation(s)
- Mostafa R Amer
- Division of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Wassim Mosleh
- Division of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Sarfaraz Memon
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Saurabh Joshi
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Bethany Sullivan
- Division of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Musa Sharkawi
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Jeffrey F Mather
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Francis J Kiernan
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Sean McMahon
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - W Lane Duvall
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Raymond G McKay
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut.
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28
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Asgar AW, Ouzounian M, Adams C, Afilalo J, Fremes S, Lauck S, Leipsic J, Piazza N, Rodes-Cabau J, Welsh R, Wijeysundera HC, Webb JG. 2019 Canadian Cardiovascular Society Position Statement for Transcatheter Aortic Valve Implantation. Can J Cardiol 2020; 35:1437-1448. [PMID: 31679616 DOI: 10.1016/j.cjca.2019.08.011] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) or replacement has rapidly changed the treatment of patients with severe symptomatic aortic stenosis. It is now the standard of care for patients believed to be inoperable or at high surgical risk, and a reasonable alternative to surgical aortic valve replacement for those at intermediate surgical risk. Recent clinical trial data have shown the benefits of this technology in patients at low surgical risk as well. This update of the 2012 Canadian Cardiovascular Society TAVI position statement incorporates clinical evidence to provide a practical framework for patient selection that does not rely on surgical risk scores but rather on individual patient evaluation of risk and benefit from either TAVI or surgical aortic valve replacement. In addition, this statement features new wait time categories and treatment time goals for patients accepted for TAVI. Institutional requirements and recommendations for operator training and maintenance of competency have also been revised to reflect current standards. Procedural considerations such as decision-making for concomitant coronary intervention, antiplatelet therapy after intervention, and follow-up guidelines are also discussed. Finally, we suggest that all patients with aortic stenosis might benefit from evaluation by the heart team to determine the optimal individualized treatment decision.
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Affiliation(s)
- Anita W Asgar
- Institut de Cardiologie de Montreal, Universite de Montreal, Montreal, Quebec, Canada.
| | - Maral Ouzounian
- Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Corey Adams
- Health Sciences Centre, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Stephen Fremes
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Lauck
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Leipsic
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Josep Rodes-Cabau
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Universite de Laval, Quebec, Quebec, Canada
| | - Robert Welsh
- Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, Alberta, Canada
| | | | - John G Webb
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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29
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Lee HA, Su IL, Chen SW, Wu VCC, Chen DY, Chu PH, Chou AH, Cheng YT, Lin PJ, Tsai FC. Direct aortic route versus transaxillary route for transcatheter aortic valve replacement: a systematic review and meta-analysis. PeerJ 2020; 8:e9102. [PMID: 32435538 PMCID: PMC7227658 DOI: 10.7717/peerj.9102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/09/2020] [Indexed: 11/20/2022] Open
Abstract
Background The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels. Transaxillary (TAx) and direct aortic (DAo) routes are the principal nonfemoral TAVR routes; however, few studies have compared their outcomes. Methods We performed a systematic review and meta-analysis to compare the rates of mortality, stroke, and other adverse events of TAx and DAo TAVR. The study was prospectively registered with PROSPERO (registration number: CRD42017069788). We searched Medline, PubMed, Embase, and Cochrane databases for studies reporting the outcomes of DAo or TAx TAVR in at least 10 patients. Studies that did not use the Valve Academic Research Consortium definitions were excluded. We included studies that did not directly compare the two approaches and then pooled rates of events from the included studies for comparison. Results In total, 31 studies were included in the quantitative meta-analysis, with 2,883 and 2,172 patients in the DAo and TAx TAVR groups, respectively. Compared with TAx TAVR, DAo TAVR had a lower Society of Thoracic Surgery (STS) score, shorter fluoroscopic time, and less contrast volume use. The 30-day mortality rates were significantly higher in the DAo TAVR group (9.6%, 95% confidence interval (CI) = [8.4–10.9]) than in the TAx TAVR group (5.7%, 95% CI = [4.8–6.8]; P for heterogeneity <0.001). DAo TAVR was associated with a significantly lower risk of stroke in the overall study population (2.6% vs. 5.8%, P for heterogeneity <0.001) and in the subgroup of studies with a mean STS score of ≥8 (1.6% vs. 6.2%, P for heterogeneity = 0.005). DAo TAVR was also associated with lower risks of permanent pacemaker implantation (12.3% vs. 20.1%, P for heterogeneity = 0.009) and valve malposition (2.0% vs. 10.2%, P for heterogeneity = 0.023) than was TAx TAVR. Conclusions DAo TAVR increased 30-day mortality rate compared with TAx TAVR; by contrast, TAx TAVR increased postoperative stroke, permanent pacemaker implantation, and valve malposition risks compared with DAo TAVR.
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Affiliation(s)
- Hsiu-An Lee
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - I-Li Su
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ting Cheng
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Pyng-Jing Lin
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
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30
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Oneissi M, Sweid A, Tjoumakaris S, Hasan D, Gooch MR, Rosenwasser RH, Jabbour P. Access-Site Complications in Transfemoral Neuroendovascular Procedures: A Systematic Review of Incidence Rates and Management Strategies. Oper Neurosurg (Hagerstown) 2020; 19:353-363. [DOI: 10.1093/ons/opaa096] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/10/2020] [Indexed: 01/05/2023] Open
Abstract
Abstract
BACKGROUND
The femoral artery is the most common access route for cerebral angiography and neurointerventional procedures. Complications of the transfemoral approach include groin hemorrhages and hematomas, retroperitoneal hematomas, pseudoaneurysms, arteriovenous fistulas, peripheral artery occlusions, femoral nerve injuries, and access-site infections. Incidence rates vary among different randomized and nonrandomized trials, and the literature lacks a comprehensive review of this subject.
OBJECTIVE
To gather data from 16 randomized clinical trials (RCT) and 17 nonrandomized cohort studies regarding femoral access-site complications for a review paper. We also briefly discuss management strategies for these complications based on the most recent literature.
METHODS
A PubMed indexed search for all neuroendovascular clinical trials, retrospective studies, and prospective studies that reported femoral artery access-site complications in neurointerventional procedures.
RESULTS
The overall access-site complication rate in RCTs is 5.13%, while in in non-RCTs, the rate is 2.78%. The most common complication in both groups is groin hematoma followed by access-site hemorrhage and femoral pseudoaneurysm. On the other hand, wound infection was the least common complication.
CONCLUSION
The transfemoral approach in neuroendovascular procedures holds risk for several complications. This review will allow further studies to compare access-site complications between the transfemoral approach and other alternative access sites, mainly the transradial approach, which is gaining a lot of interest nowadays.
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Affiliation(s)
- Mazen Oneissi
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - David Hasan
- Department of Neurosurgery, University of Iowa, Iowa, Iowa
| | - M Reid Gooch
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert H Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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31
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Abdelaziz HK, Megaly M, Debski M, Rahbi H, Kamal D, Saad M, Wiper A, More R, Roberts DH. Meta-Analysis Comparing Percutaneous to Surgical Access in Trans-Femoral Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:1239-1248. [PMID: 32085864 DOI: 10.1016/j.amjcard.2020.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 12/17/2022]
Abstract
To compare the outcomes in trans-femoral transcatheter aortic valve implantation (TF-TAVI) performed with percutaneous approach (PC) versus surgical cut-down (SC). In 13 trials including 5,859 patients (PC = 3447, SC = 2412), the outcomes based on Valve Academic Research Consortium criteria were compared between PC and SC in TF-TAVI. Compared with SC, PC was associated with similar major vascular complications (VCs) (8.7% vs 8.5%; odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.76 to 1.15, p = 0.53), major bleeding (OR = 1.09, 95% CI = 0.66 to 1.8, p = 0.73), perioperative mortality (5.7% vs 5.2%; OR = 1.13, 95% CI = 0.85 to 1.49, p = 0.4), urgent surgical repair (OR = 1.27, 95% CI = 0.81 to 2.02, p = 0.3), stroke (3.3% vs 3.9%; OR = 0.85, 95% CI = 0.53 to 1.36, p = 0.5), myocardial infarction (1.3% vs 1.1%; OR = 1.06, 95% CI = 0.53 to 2.12, p = 0.86), and renal failure (5.2% vs 5.9%; OR = 0.68, 95% CI = 0.38 to 1.22, p = 0.2), but shorter hospital stay (9.1 ± 8.5 vs 9.6 ± 9.5 days; mean difference = -1.07 day, 95% CI = -2.0 to -0.15, p = 0.02) and less blood transfusion (18.5% vs 25.7%; OR = 0.61, 95% CI = 0.43-0.86, p = 0.005). Minor VCs occurred more frequently in PC compared to SC (11.9% vs 6.9%; OR = 1.67, 95% CI = 1.04-2.67, p = 0.03). In conclusion, in TF-TAVI, PC is a safe and feasible alternative to SC, and adopting either approach depends on operator experience after ensuring that vascular access could be safely achieved with that specific technique.
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32
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Comparison of clinical outcomes after transcarotid and transsubclavian versus transfemoral transcatheter aortic valve implantation: A propensity-matched analysis. Arch Cardiovasc Dis 2020; 113:189-198. [DOI: 10.1016/j.acvd.2020.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/10/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022]
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Implante sin introductor de válvula Portico por acceso transaxilar. Experiencia inicial de un «equipo multidisciplinario» real. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Comparative Outcomes of Transcarotid and Transsubclavian Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2020; 109:49-56. [DOI: 10.1016/j.athoracsur.2019.05.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 11/20/2022]
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Cook SA, Navas-Blanco JR, Acho C, Han X, Wyman J, Szymanski TJ. Comparison of Patient Outcomes of Transfemoral Transcatheter Aortic Valve Replacement Using Pre-Sedation Radial Versus Post-Sedation Femoral Arterial Sites for Blood Pressure Monitoring. J Cardiothorac Vasc Anesth 2019; 33:3303-3308. [DOI: 10.1053/j.jvca.2019.01.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 11/11/2022]
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Should All Low-risk Patients Now Be Considered for TAVR? Operative Risk, Clinical, and Anatomic Considerations. Curr Cardiol Rep 2019; 21:161. [PMID: 31781976 DOI: 10.1007/s11886-019-1250-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This article reviews the current data on TAVR in low-risk patients with severe, symptomatic aortic stenosis, highlights the results of the recently published Medtronic Low Risk Randomized Study and PARTNER 3 trials, and describes specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice in this population. RECENT FINDINGS In low-risk patients, the Medtronic Low Risk Randomized Study demonstrated TAVR to be non-inferior to surgery with respect to the composite endpoint of death or disabling stroke while PARTNER 3 trial proved TAVR to be superior to surgery with regard to the composite endpoint of death, stroke, or rehospitalization. Recent trials demonstrate the safety and efficacy of TAVR in low-risk patients and have led to an FDA indication for the use of TAVR in these patients. However, the lack of long-term data on the rate of transcatheter valve deterioration in the younger population, higher incidence of paravalvular leak and pacemaker implantation following TAVR, along with certain intrinsic anatomic factors remain potential challenges to generalize TAVR in all low surgical risk patients. We describe specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice for low-risk patients with severe, symptomatic AS.
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Cardenal Piris RM, Araji Tiliani O, Díaz Fernández JF, Miranda Balbuena N, Gómez Menchero A, Barquero Aroca JM. Sheathless transaxillary transcatheter aortic valve implantation using the Portico valve system. Initial experience of a real-world "Heart Team". ACTA ACUST UNITED AC 2019; 73:178-180. [PMID: 31699642 DOI: 10.1016/j.rec.2019.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/01/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Rosa María Cardenal Piris
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Juan Ramón Jiménez, Huelva, Spain.
| | - Omar Araji Tiliani
- Servicio de Cirugía Cardiovascular, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Nuria Miranda Balbuena
- Servicio de Cirugía Cardiovascular, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Antonio Gómez Menchero
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Juan Ramón Jiménez, Huelva, Spain
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Howard C, Jullian L, Joshi M, Noshirwani A, Bashir M, Harky A. TAVI and the future of aortic valve replacement. J Card Surg 2019; 34:1577-1590. [PMID: 31600005 DOI: 10.1111/jocs.14226] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aortic valve stenosis (AS) is the most common valvular pathology and has traditionally been managed using surgical aortic valve replacement (SAVR). A large proportion of affected patient demographics, however, are unfit to undergo major surgery given underlying comorbidities. Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has gained popularity and transformed the care available to different-risk group patients with severe symptomatic AS. Specific qualifying criteria and refinement of TAVI techniques are fundamental in determining successful outcomes for intervention. Given the successful applicability in high-risk patients, TAVI has been further developed and trialed in intermediate and low-risk patients. Within intermediate-risk patient groups, TAVI was shown to be noninferior to SAVR evaluating 30-d mortality and secondary endpoints such as the risk of bleeding, development of acute kidney injury, and length of admission. The feasibility of expanding TAVI procedures into low-risk patients is still a controversial topic in the literature. A number of trials have recently been published which demonstrate TAVI as noninferior and even superior over SAVR for primary study endpoints.
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Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lucas Jullian
- Department of Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Mihika Joshi
- Department of Cardiology, Countess of Chester Hospital, Chester, UK
| | - Arish Noshirwani
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mohamad Bashir
- Department of Aortovascular Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Prasitlumkum N, Kittipibul V, Tokavanich N, Kewcharoen J, Rattanawong P, Angsubhakorn N, Mao MA, Gillaspie EA, Cheungpasitporn W. Baseline significant tricuspid regurgitation is associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2019; 20:477-486. [PMID: 31593560 DOI: 10.2459/jcm.0000000000000807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Significant tricuspid regurgitation is a well recognized indicator of right ventricular dysfunction. Recent studies have shown that significant tricuspid regurgitation is potentially associated with increased mortality in patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR). However, data remained sparse and inconclusive. Thus, we performed a systematic review and meta-analysis of the literature to assess the association between significant tricuspid regurgitation and mortality in post TAVR patients. HYPOTHESIS Significant tricuspid regurgitation is predictive for higher mortality in patients undergoing TAVR. METHODS We comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published observational studies that reported multivariate analysis of the effects of significant tricuspid regurgitation on all-cause mortality among patients undergoing TAVR. Data from each study were combined utilizing the random-effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Nine cohort studies from August 2011 to May 2018 consisting of 27 614 patients with severe aortic stenosis undergoing TAVR (6255 with and 21 359 without significant tricuspid regurgitation) were included in this meta-analysis. The presence of significant tricuspid regurgitation was associated with higher all-cause mortality (pooled OR = 2.26, 95% CI: 1.45-3.52, P < 0.001). We found that all-cause mortality remained statistically substantial in all subgroups (30-day all-cause mortality: OR = 2.05, 95% CI: 1.20-3.49, P = 0.009; midterm all-cause mortality: OR = 9.67, 95% CI: 2.44-38.31, P = 0.001; and long-term all-cause mortality: OR = 1.48, 95% CI: 1.19-1.85, P < 0.001). Funnel plots and Egger's regression asymmetry test were performed and showed no publication bias. CONCLUSION Significant tricuspid regurgitation increased risk of mortality by up to two-fold among patients with severe aortic stenosis undergoing TAVR. Our study suggests that significant tricuspid regurgitation should be considered a component of risk stratification tools.
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Affiliation(s)
- Narut Prasitlumkum
- Department of Internal Medicine, University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii
| | - Veraprapas Kittipibul
- Department of Internal Medicine, Jackson Memorial Hospital Internal Medicine Residency Program, Miami, Florida, USA
| | | | - Jakrin Kewcharoen
- Department of Internal Medicine, University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii
| | - Pattara Rattanawong
- Department of Internal Medicine, University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii.,Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Michael A Mao
- Division of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Erin A Gillaspie
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wisit Cheungpasitporn
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Allen KB, Chhatriwalla AK, Cohen D, Saxon J, Hawa Z, Kennedy KF, Aggarwal S, Davis R, Pak A, Borkon AM. Transcarotid Versus Transapical and Transaortic Access for Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2019; 108:715-722. [DOI: 10.1016/j.athoracsur.2019.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/18/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
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Dawson LP, Dagan M, Koh Y, Duffy SJ, Stub D, Lew P, Shaw JA, Walton A. Factors That Prevent Progression to Transcatheter Aortic Valve Implantation (TAVI). Heart Lung Circ 2019; 28:1225-1234. [DOI: 10.1016/j.hlc.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/14/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022]
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Delirium is associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis. Cardiovasc Interv Ther 2019; 35:168-176. [DOI: 10.1007/s12928-019-00592-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/23/2019] [Indexed: 12/15/2022]
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Ueshima D, Barioli A, Nai Fovino L, D'Amico G, Fabris T, Brener SJ, Tarantini G. The impact of pre‐existing peripheral artery disease on transcatheter aortic valve implantation outcomes: A systematic review and meta‐analysis. Catheter Cardiovasc Interv 2019; 95:993-1000. [DOI: 10.1002/ccd.28335] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Daisuke Ueshima
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Alberto Barioli
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Luca Nai Fovino
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Gianpiero D'Amico
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Tommaso Fabris
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Sorin J. Brener
- Department of Medicine, Cardiac Catheterization LaboratoryNew York‐Presbyterian Brooklyn Methodist Hospital Brooklyn New York
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
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Comparison of early and midterm outcomes after transsubclavian/axillary versus transfemoral, transapical, or transaortic transcatheter aortic valve implantation. Heart Lung 2019; 48:519-529. [PMID: 31076179 DOI: 10.1016/j.hrtlng.2019.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/30/2019] [Accepted: 04/05/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Outcomes after transsubclavian/transaxillary (TSc/TAx)-transcatheter aortic valve implantation (TAVI) have been unclear. OBJECTIVES To compare outcomes after TSc/TAx-TAVI versus transfemoral (TF)-TAVI, transapical (TAp)-TAVI, or transaortic (TAo)-TAVI, we performed meta-analysis of currently available studies. METHODS Studies considered for inclusion met the following criteria: the study population was patients undergoing TAVI; patients were assigned to TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least one of postprocedural early (30-day or in-hospital) or late (including early) outcomes was reported. An odds or hazard ratio of each early or late outcome with its 95% confidence interval for TSc/TAx-TAVI versus the other approach was extracted from each individual study and combined in the random-effects model. RESULTS Our search identified 15 eligible reports from 12 studies including 10,528 patients. Pooled analysis of early all-cause mortality demonstrated a statistically significant reduction after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.003) or TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.0001) or TAo-TAVI (P < 0.00001). Pooled analysis of midterm all-cause mortality demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007). CONCLUSIONS Early all-cause mortality was lower after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm all-cause mortality was higher after TSc/TAx-TAVI than TF-TAVI.
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Fischer-Rasokat U, Renker M, Liebetrau C, van Linden A, Arsalan M, Weferling M, Rolf A, Doss M, Möllmann H, Walther T, Hamm CW, Kim WK. 1-Year Survival After TAVR of Patients With Low-Flow, Low-Gradient and High-Gradient Aortic Valve Stenosis in Matched Study Populations. JACC Cardiovasc Interv 2019; 12:752-763. [DOI: 10.1016/j.jcin.2019.01.233] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/09/2019] [Accepted: 01/22/2019] [Indexed: 01/27/2023]
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Abawi M, Gils L, Agostoni P, Mieghem NM, Kooistra NHM, Dongen CS, Jaarsveld RC, Jaegere PPT, Doevendans PAFM, Stella PR. Impact of baseline cigarette smoking status on clinical outcome after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 94:795-805. [DOI: 10.1002/ccd.28175] [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: 11/28/2018] [Revised: 02/05/2019] [Accepted: 02/18/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Masieh Abawi
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Lennart Gils
- Department of Interventional CardiologyErasmus Medical Center Rotterdam The Netherlands
| | - Pierfrancesco Agostoni
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
- Department of CardiologyHartcentrum, ZNA Antwerp Belgiccdum
| | - Nicolas M. Mieghem
- Department of Interventional CardiologyErasmus Medical Center Rotterdam The Netherlands
| | - Nynke H. M. Kooistra
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Charlotte S. Dongen
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Romy C. Jaarsveld
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Peter P. T. Jaegere
- Department of Interventional CardiologyErasmus Medical Center Rotterdam The Netherlands
| | - Pieter A. F. M. Doevendans
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
- Netherlands Heart Institute Utrecht The Netherlands
| | - Pieter R. Stella
- Department of CardiologyUniversity Medical Center Utrecht, Utrecht University Utrecht The Netherlands
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Mehilli J, Chandrasekhar J, Sartori S, Chieffo A, Petronio AS, Lefèvre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Jochheim D, Zadrozny M, Mikhail GW, Sharma S, Ferrer MC, Naber C, Kievit P, Moalem K, Baber U, Snyder C, Sharma M, Morice MC, Mehran R. Impact of Discharge Location After Transcatheter Aortic Valve Replacement on 1-Year Outcomes in Women: Results From the WIN-TAVI Registry. Can J Cardiol 2019; 35:199-207. [DOI: 10.1016/j.cjca.2018.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/14/2018] [Accepted: 11/22/2018] [Indexed: 01/09/2023] Open
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Yaku H, Saito N, Imai M, Sakamoto K, Toyota T, Watanabe H, Taniguchi T, Shiomi H, Imada K, Seo H, Yamazaki K, Kimura T. Utility of a 3-Dimensional Printed Model to Simulate Transcatheter Aortic Valve Implantation in a Patient With an Intramural Hematoma and a Penetrating Atherosclerotic Ulcer in the Distal Aortic Arch. Circ Cardiovasc Interv 2018; 11:e006925. [PMID: 30562089 DOI: 10.1161/circinterventions.118.006925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hidenori Yaku
- Department of Cardiovascular Medicine (H.Y., N.S., M.I., T.Toyota, H.W., T. Taniguchi, H.S., K.I., T.K.), Graduate School of Medicine, Kyoto University, Japan
| | - Naritatsu Saito
- Department of Cardiovascular Medicine (H.Y., N.S., M.I., T.Toyota, H.W., T. Taniguchi, H.S., K.I., T.K.), Graduate School of Medicine, Kyoto University, Japan
| | - Masao Imai
- Department of Cardiovascular Medicine (H.Y., N.S., M.I., T.Toyota, H.W., T. Taniguchi, H.S., K.I., T.K.), Graduate School of Medicine, Kyoto University, Japan
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Surgery (K.S., K.Y.), Graduate School of Medicine, Kyoto University, Japan
| | - Toshiaki Toyota
- Department of Cardiovascular Medicine (H.Y., N.S., M.I., T.Toyota, H.W., T. Taniguchi, H.S., K.I., T.K.), Graduate School of Medicine, Kyoto University, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine (H.Y., N.S., M.I., T.Toyota, H.W., T. Taniguchi, H.S., K.I., T.K.), Graduate School of Medicine, Kyoto University, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine (H.Y., N.S., M.I., T.Toyota, H.W., T. Taniguchi, H.S., K.I., T.K.), Graduate School of Medicine, Kyoto University, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine (H.Y., N.S., M.I., T.Toyota, H.W., T. Taniguchi, H.S., K.I., T.K.), Graduate School of Medicine, Kyoto University, Japan
| | - Kazuaki Imada
- Department of Cardiovascular Medicine (H.Y., N.S., M.I., T.Toyota, H.W., T. Taniguchi, H.S., K.I., T.K.), Graduate School of Medicine, Kyoto University, Japan
| | - Hideya Seo
- Department of Anesthesiology (H.S.), Graduate School of Medicine, Kyoto University, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery (K.S., K.Y.), Graduate School of Medicine, Kyoto University, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine (H.Y., N.S., M.I., T.Toyota, H.W., T. Taniguchi, H.S., K.I., T.K.), Graduate School of Medicine, Kyoto University, Japan
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50
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Holmes DR. Traveling Companions. JACC Cardiovasc Interv 2018; 11:2193-2194. [PMID: 30343024 DOI: 10.1016/j.jcin.2018.07.010] [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: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 11/15/2022]
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