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Zhan Y, Saadat S, Soin A, Kawabori M, Chen FY. A meta-analysis comparing transaxillary and transfemoral transcatheter aortic valve replacement. J Thorac Dis 2019; 11:5140-5151. [PMID: 32030231 DOI: 10.21037/jtd.2019.12.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background While transfemoral (TF) approach is considered as the default access for transcatheter aortic valve replacement (TAVR), the alternative access route of choice remains to be elucidated. Transaxillary (TAx) approach has shown promise as an excellent option. We performed a meta-analysis of the studies comparing the TF and TAx approaches using one type of self-expandable transcatheter valve to avoid device-related bias. Methods We searched PubMed/MEDLINE, EMBASE, and the Cochrane Library from inception to December 2018 to identify articles comparing TAx-TAVR and TF-TAVR. The studies included in this meta-analysis contain data related to the use of the CoreValve device. Patients' baseline characteristics, procedural outcomes, and clinical outcomes were extracted from the articles and pooled for analysis. Results The meta-analysis included five studies comprising 1,414 patients in the TF group and 489 patients in the TAx group. The average EuroScores of the TF and TAx groups were 20.04±13.89 and 22.73±14.73, respectively. The TAx group has higher rates of major comorbidities. No difference was found between the two groups with regard to vascular complications (P=0.71; OR 1.08; 95% CI, 0.71-1.65), aortic regurgitation (P=0.90; OR 1.03; 95% CI, 0.71-1.49), and permanent pacemaker (PPM) implantation (P=0.42; OR 1.12; 95% CI, 0.86-1.46). The TAx group has a lower incidence of acute kidney injury (AKI) (P=0.05; OR 1.63; 95% CI, 1.01-2.62). No difference was observed in 30-day mortality (P=0.32; OR 1.30; 95% CI, 0.78-2.17) or 1-year mortality (P=0.21; OR 0.76; 95% CI, 0.50-1.16). Conclusions TAx-TAVR is associated with overall comparable outcomes to TF TAVR in high-risk patient cohorts, despite higher incidences of major comorbidities in the TAx-TAVR patient population. The rate of AKI appears to be lower after TAx-TAVR.
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Affiliation(s)
- Yong Zhan
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Siavash Saadat
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Avneet Soin
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Masashi Kawabori
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Frederick Y Chen
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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Kakizaki R, Meguro K, Kitamura T, Hashimoto T, Ako J. Transaortic Access Using Vascular Graft for Transcatheter Aortic Valve Implantation. Int Heart J 2019; 60:990-993. [PMID: 31204375 DOI: 10.1536/ihj.18-591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 92-year-old man with acute heart failure due to severe aortic stenosis underwent transcatheter aortic valve implantation (TAVI). Computed tomography demonstrated severe stenosis of the right common iliac artery, occlusion of the left external iliac artery, and stenosis of the left subclavian artery. Severe calcification was observed in the sinotubular junction, which was considered a risk factor for aortic dissection with transapical TAVI using a balloon-expanding bioprosthetic valve. Therefore, transaortic (TAo) access was the only option for this high-risk surgical patient. As the maximum distance from the aortic valve annulus to the sheath insertion point was less than 60 mm, TAVI was performed transaortically using a vascular graft that extended this distance, in order to avoid sheath dislocation. Our experience demonstrates that vascular graft application is a viable option in patients with an inadequate distance between the aortic valve annulus and the puncture site in TAo-TAVI.
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Affiliation(s)
- Ryota Kakizaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Takuya Hashimoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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Chiocchi M, Forcina M, Morosetti D, Pugliese L, Cavallo AU, Citraro D, De Stasio V, Presicce M, Floris R, Romeo F. The role of computed tomography in the planning of transcatheter aortic valve implantation: a retrospective analysis in 200 procedures. J Cardiovasc Med (Hagerstown) 2019; 19:571-578. [PMID: 30015782 DOI: 10.2459/jcm.0000000000000695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM The aim of our study is to show the importance of multislice computed tomography (CT) assessment in the overall management and diagnostic framework of transcatheter aortic valve replacement (TAVI) procedure candidates. METHODS Between June 2015 and April 2017, 200 patients with severe aortic stenosis, not eligible for surgery, were enrolled, as defined by EuroSCORE; they were submitted to TAVI at the interventional cardiology department of the Tor Vergata Polyclinic. CT studies were performed using a 64-slice scanner. RESULTS The reports and datasets produced during the pre-TAVI CT evaluation were retrospectively evaluated. DISCUSSION In TAVI candidates, accurate aortic valve shape and dimensions evaluation is crucial for the proper deployment of the prosthetic valve and in order to reduce postprocedural complications. ECG retrospective gated cardiac CT gives the clinician three-dimensional images of the heart, with high spatial resolution and multiplanar reconstructions allowing accurate visualization of the aortic annulus and coronary ostia to be obtained, and the evaluation of arterial calcifications. Furthermore, CT can provide data on the suitability of peripheral vascular accesses. Moreover, this technique can point out the presence of clinically relevant extracardiac findings. Therefore, CT evaluation assures a safe, reliable and prognostically relevant method for TAVI preprocedural planning. CONCLUSION Our study remarks the importance of CT assessment in the overall management and diagnostic framework of TAVI candidates; the information provided is essential in order to minimize possible complications and to improve the quality of the therapeutic planning.
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Affiliation(s)
- Marcello Chiocchi
- Fondazione PTV Policlinico Tor Vergata, Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Rome, Italy
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4
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Fathala A, Bin Saeedan M, Zulfiqar A, Al Sergani H. Non-Cardiovascular Computed Tomography Incidental Findings in Patients Who Underwent Transaortic Valve Implantation Procedure. Cardiol Res 2017; 8:13-19. [PMID: 28275420 PMCID: PMC5340520 DOI: 10.14740/cr445w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 12/29/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a new treatment option for patients with severe aortic stenosis. Pre-TAVI procedure workup includes computed tomography angiography (CTA) of the heart and aorta from aortic annulus to the iliofemoral arteries. Frequently, there are a number of incidental non-cardiac findings (INCFs) in pre-TAVI CTA. However, the frequency and clinical significance of these INCFs are unknown. The aim of our study was to investigate the prevalence of INCFs and their clinical significance. Methods This was a retrospective review of 67 patients who underwent dedicated pre-TAVI CTA from 2010 till 2015. Non-cardiovascular INCFs were classified according to their clinical significance into three categories. The first category includes findings that may require urgent treatment. The second category includes findings that need further follow-up. The third category includes incidental findings that require no further follow-up or recommendation. Results The total number of patients was 67, and the mean age was 73 ± 8 years. All patients had INCFs and the total number was 248. Of the patients, 69% had chest findings, 85% had abdominal findings, and 33% had musculoskeletal findings. Results based on categorical classification were as follows: 9%, 25%, and 66% of these 248 findings belong to the first category, the second category, and the third category, respectively. Conclusion Non-cardiovascular INCFs are common in pre-TAVI CTA presumably due to increased age of such specific population. These findings have variable clinical significance and some of them might require acute treatment or additional evaluation, and should be managed properly taking into consideration patient’s life expectancy and comorbidities.
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Affiliation(s)
- Ahmed Fathala
- Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mnahi Bin Saeedan
- Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ali Zulfiqar
- King Faisal Heart Institute, Riyadh, Saudi Arabia
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Jones BM, Kapadia SR, Krishnaswamy A, Mick S, Tuzcu EM. Transfemoral Aortic Valve Implantation. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Vymazal T. Minimally invasive approach to calcified aortic valve replacement: Anaesthetic considerations. Indian J Anaesth 2015. [PMID: 26195828 PMCID: PMC4481751 DOI: 10.4103/0019-5049.158731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
For symptomatic patients with severe calcified aortic valve stenosis, open heart surgery for aortic valve replacement remains the gold standard. However, elderly patients with an increased risk profile can be treated by using transcatheter approaches (transcatheter aortic valve implantation [TAVI]). The major considerations related to use of general and local anaesthesia for TAVI are discussed in this review.
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Affiliation(s)
- Tomas Vymazal
- Department of Anesthesiology and Intensive Care Medicine, 2 School of Medicine, Charles University, V Úvalu 84, 15000 Prague 5, Czech Republic
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7
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Bruschi G, Botta L, Cannata A, Colombo P, Barosi A, Soriano F, Bottiroli M, Nava S, Klugmann S, De Marco F. First case of trans-axillary direct flow implantation. Int J Cardiol 2014; 177:e176-8. [PMID: 25189491 DOI: 10.1016/j.ijcard.2014.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Giuseppe Bruschi
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy.
| | - Luca Botta
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Aldo Cannata
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Paola Colombo
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Alberto Barosi
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Francesco Soriano
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Maurizio Bottiroli
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Stefano Nava
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Silvio Klugmann
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
| | - Federico De Marco
- Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Italy
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8
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Direct aorta ascending approach in transcatheter aortic valve implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:1-9. [PMID: 24553056 DOI: 10.1097/imi.0000000000000046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Direct aorta ascending approach [transaortic approach (TAo)] is a new access way for transcatheter aortic valve implantation (TAVI) to be used in patients with peripheral vascular disease and as an alternative to transapical approach. METHODS Both the Edwards SAPIEN and CoreValve systems were used. Depending on the position of the ascending aorta, the relation to the sternum, the brachiocephalic vein, vein grafts, and left and right internal mammary artery grafts from previous heart surgery, either right minithoracotomy or left ministernotomy was selected. Computed tomographic scan with reconstruction was applied for this decision making. A hybrid operating room was used with echocardiographic and fluoroscopy guidance. RESULTS We have done 30 procedures via the aorta ascendens. The mean age of the patients was 80 years, and 18 were men. The mean Logistic EuroSCORE of 33 reflects the comorbidities. More than half of the patients had coronary vessel disease and had undergone coronary artery bypass graft; 20% had abdominal aortic aneurysm. The mean ejection fraction was 41%, and the patients were in New York Heart Association class III to IV. The mean gradient was 50 mm Hg, and the mean valve area was 0.7 cm. The mean valve size was 28 mm. The use of Edwards SAPIEN versus CoreValve was 50%/50%, and thoracotomy versus sternotomy was 9 versus 21. All procedures were done successfully, but one patient had a periprocedural valve-in-valve implantation. Twenty-two patients were extubated in the operation room. The patients stayed in the intensive care unit for one night. Six patients were reoperated on. One patient had a postoperative balloon aortic valvuloplasty. The overall survival was 81% (follow up, 1-18 months). CONCLUSIONS Access design is an important issue in TAVI. When central approach is needed, TAVI-TAo is safe. For patients with low ejection fraction, the TAVI-TAo is preferred to the TAVI-transapical. The cannulation technique of the aorta is well known for cardiothoracic surgeons, and the method is feasible both for the Medtronic CoreValve and the Edwards SAPIEN valve, either via right minithoracotomy or ministernotomy to obtain the best coaxial alignment. It seems easier to position the bigger valves more precisely via this central approach.
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9
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Amrane H, Porta F, van Boven AJ, Boonstra PW, Hofma SH, Head SJ, Kappetein AP. Transcatheter aortic valve implantation using a direct aortic approach: a single-centre Heart Team experience. Interact Cardiovasc Thorac Surg 2014; 19:777-81. [DOI: 10.1093/icvts/ivu247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Abstract
With the improvement in the overall life expectancy, the incidence of aortic stenosis has been increasing. Although aortic valve replacement is a standard therapy, many patients do not undergo surgery for various reasons, including advanced age or the presence of multiple comorbidities. Transcatheter aortic valve implantation (TAVI) has been proposed as a less invasive and equally effective treatment for inoperable or high-risk symptomatic aortic stenosis. Numerous rigorous global clinical trials, as well as a pivotal clinical trial in Japan, have been conducted. In this review, we provide data on the development of TAVI worldwide and discuss the prospects for TAVI in Japan.
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11
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Staab W, Bergau L, Lotz J, Sohns C. Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2014; 8:222-9. [DOI: 10.1016/j.jcct.2014.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/09/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
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12
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Oteo JF, Trillo R, García-Touchard A, Fernández-Díaz JA, Cavero MA, Goicolea J. A first case of totally percutaneous transaxillary aortic valve implantation. ACTA ACUST UNITED AC 2014; 66:220-2. [PMID: 24775458 DOI: 10.1016/j.rec.2012.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 06/12/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Juan F Oteo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Ramiro Trillo
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Arturo García-Touchard
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José A Fernández-Díaz
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Miguel A Cavero
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Javier Goicolea
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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13
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Antonis P, Gooley R, Moshinsky R, Meredith IT. Sheathless transcatheter aortic valve implantation via the direct aortic approach. Catheter Cardiovasc Interv 2014; 83:493-6. [PMID: 23765680 DOI: 10.1002/ccd.25050] [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: 05/06/2013] [Accepted: 06/01/2013] [Indexed: 11/07/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become an accepted alternate treatment modality to surgical aortic valve replacement in high surgical risk patients. There remains, however, a subset of patients in whom safe delivery of a TAVR device cannot be achieved by the femoral or subclavian routes. In such cases the direct aortic or transapical routes can be used though this still requires suitable anatomy. We present the first reported case of a direct aortic TAVR using a sheathless technique in order to provide sufficient distance to safely deliver the prosthesis.
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Affiliation(s)
- Paul Antonis
- MonashHeart, Monash Health, Melbourne, Australia; Monash Cardiovascular Research Centre, Department of Medicine, Monash University, Melbourne, Australia
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Al Kindi AH, Salhab KF, Roselli EE, Kapadia S, Tuzcu EM, Svensson LG. Alternative access options for transcatheter aortic valve replacement in patients with no conventional access and chest pathology. J Thorac Cardiovasc Surg 2014; 147:644-51. [DOI: 10.1016/j.jtcvs.2013.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 01/27/2013] [Accepted: 02/12/2013] [Indexed: 01/24/2023]
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15
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Dahle G, Rein KA. Direct Aorta Ascending Approach in Transcatheter Aortic Valve Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gry Dahle
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Kjell-Arne Rein
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
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16
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Petronio AS, De Carlo M, Giannini C, De Caro F, Bortolotti U. Subclavian TAVI: more than an alternative access route. EUROINTERVENTION 2013; 9 Suppl:S33-7. [DOI: 10.4244/eijv9ssa7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Mylotte D, Martucci G, Piazza N. Patient selection for transcatheter aortic valve implantation: An interventional cardiology perspective. Ann Cardiothorac Surg 2013; 1:206-15. [PMID: 23977496 DOI: 10.3978/j.issn.2225-319x.2012.06.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 06/18/2012] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as a highly effective minimally invasive treatment symptomatic for severe calcific aortic stenosis in patients at high or prohibitive surgical risk. The success of TAVI has been determined by a number of factors, but in particular by appropriate patient selection. Appropriate patient selection involves identifying patients with the potential to benefit most from TAVI and individualizing the bioprosthesis type and size, and the vascular access site for each case. We present herein, our critical appraisal on patient selection for TAVI: an interventional cardiology perspective.
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Affiliation(s)
- Darrren Mylotte
- Department of Interventional Cardiology at McGill University Health Centre (MUHC), Montreal, Canada
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18
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Noble S. Transapical aortic valve implantation: a reasonable therapeutic option, but not the only alternative to transfemoral approach. J Thorac Dis 2013; 5:360-1. [PMID: 23825775 DOI: 10.3978/j.issn.2072-1439.2013.06.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/10/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Stephane Noble
- Department of Medical Specialties, Interventional Cardiology Unit, University Hospital of Geneva, Switzerland
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20
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Clarke A, Wiemers P, Poon KK, Aroney CN, Scalia G, Burstow D, Walters DL, Tesar P. Early Experience of Transaortic TAVI—The Future of Surgical TAVI? Heart Lung Circ 2013; 22:265-9. [DOI: 10.1016/j.hlc.2012.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 10/21/2012] [Accepted: 11/01/2012] [Indexed: 11/16/2022]
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22
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Bruschi G, Botta L, De Marco F, Colombo P, Nonini S, Klugmann S, Martinelli L. Direct aortic transcatheter valve implantation via mini-thoracotomy using the Medtronic CoreValve. Multimed Man Cardiothorac Surg 2013; 2013:mmt015. [PMID: 24448561 DOI: 10.1093/mmcts/mmt015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Transcatheter aortic valve implantation using the Medtronic CoreValve is a well-established procedure. Although previously carried out only through the common femoral artery, today it is possible to perform the procedure through different arterial alternative access sites. A direct aortic approach through the ascending aorta could be carried out via a right anterior mini-thoracotomy in the second intercostal space. The pericardium is opened to expose the aorta. Two purse-string sutures are then placed on the ascending aorta and a standard retrograde CoreValve implantation is performed with the standard delivery system. Advantages, contraindications, surgical technique and results are discussed.
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Affiliation(s)
- Giuseppe Bruschi
- 'A. De Gasperis' Cardiology and Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy
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23
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Testa L, Brambilla N, Laudisa ML, De Carlo M, Lanotte S, Latini RA, Pizzocri S, Casavecchia M, Agnifili ML, Giannini C, Bortolotti U, Petronio AS, Bedogni F. Right subclavian approach as a feasible alternative for transcatheter aortic valve implantation with the CoreValve ReValving System. EUROINTERVENTION 2012; 8:685-90. [DOI: 10.4244/eijv8i6a107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Philipsen TE, Rodrigus IE, Claeys MJ, Bosmans JM. Alternative Access in Transcatheter Aortic Valve Implantation: Brachiocephalic Artery Access. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tine E. Philipsen
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Inez E. Rodrigus
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc J. Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Johan M. Bosmans
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
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25
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Alternative Access in Transcatheter Aortic Valve Implantation: Brachiocephalic Artery Access. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 7:372-5. [DOI: 10.1097/imi.0b013e31827e5934] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Direct ascending aortic access is an accepted alternative approach for transcatheter aortic valve implantation (TAVI) that can be preferred in case of excessive atherosclerosis or small caliber of femoral and subclavian vessels or after previous coronary artery bypass grafting with a patent left internal mammary artery graft. However, not all patients are suitable for this direct aortic approach. In these patients, we now use direct access through the brachiocephalic artery. The direct brachiocephalic access can be obtained with or without partial upper sternotomy, depending on the anatomy, which should be evaluated by preprocedural angiographic computed tomography scan. During the procedure, the cerebral tissue oxygen saturation is continuously monitored. We treated two patients with severe aortic valve stenosis, classified as not suitable for surgical aortic valve replacement, by means of TAVI through the brachiocephalic artery. Both patients had excessive iliac atherosclerotic disease. One had patent left internal mammary artery and venous grafts after previous coronary artery bypass grafting so the femoral, direct aortic, nor left subclavian access was suitable; the other had a severely atheromatous and calcified aorta. No procedural or late complications were seen. If transfemoral, subclavian, and direct aortic accesses for TAVI are contraindicated, the direct brachiocephalic access seems to be a safe and feasible alternative.
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26
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Snow TM, Moat N, Barker S, Duncan A, Di Mario C. Transcatheter aortic valve implantation. Glob Cardiol Sci Pract 2012; 2012:12. [PMID: 25610843 PMCID: PMC4239814 DOI: 10.5339/gcsp.2012.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 05/17/2012] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas M Snow
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Neil Moat
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Sarah Barker
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Alison Duncan
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Carlo Di Mario
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
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Petronio AS, De Carlo M, Bedogni F, Maisano F, Ettori F, Klugmann S, Poli A, Marzocchi A, Santoro G, Napodano M, Ussia GP, Giannini C, Brambilla N, Colombo A. 2-year results of CoreValve implantation through the subclavian access: a propensity-matched comparison with the femoral access. J Am Coll Cardiol 2012; 60:502-7. [PMID: 22726631 DOI: 10.1016/j.jacc.2012.04.014] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 03/27/2012] [Accepted: 04/03/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The goal of this study was to assess the procedural and 2-year results of the subclavian approach for transcatheter aortic valve implantation (TAVI) compared with those of the femoral approach by using propensity-matched analysis. BACKGROUND The subclavian approach with the CoreValve prosthesis (Medtronic, Inc., Minneapolis, Minnesota) represents an interesting opportunity when the femoral access is unfeasible. METHODS All consecutive patients enrolled in the Italian CoreValve Registry who underwent TAVI with the subclavian approach were included. Propensity score analysis was used to identify a matching group of patients undergoing femoral TAVI. RESULTS Subclavian approach was used in 141 patients (61% men; median age 83 years; median logistic European System for Cardiac Operative Risk Evaluation score 23.7%). The femoral group of 141 patients was matched for baseline clinical characteristics, except for peripheral artery disease. The 2 groups showed similar procedural success (97.9% vs. 96.5%; p = 0.47), major vascular complications (5.0% vs. 7.8%; p = 0.33), life-threatening bleeding events (7.8% vs. 5.7%; p = 0.48), and combined safety endpoint (19.9% vs. 25.5%; p = 0.26). The subclavian group showed lower rates of acute kidney injury/stage 3 (4.3% vs. 9.9%; p = 0.02), of minor vascular complications at the 18-F sheath insertion site (2.1% vs. 11.3%; p = 0.003), and of all types of bleeding events related to vascular complications. Survival at 2 years was 74.0 ± 4.0% in the subclavian group compared with 73.7 ± 3.9% in the femoral group (p = 0.78). The 2-year freedom from cardiovascular death was 87.2 ± 3.1% versus 88.7 ± 2.8% in the subclavian versus femoral group, respectively (p = 0.84). CONCLUSIONS The subclavian approach for TAVI is safe and feasible, with procedural and medium-term results similar to the femoral approach. Subclavian access should be considered a valid option not only when the femoral approach is impossible but also when it is difficult, albeit feasible.
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Affiliation(s)
- Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
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28
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Chan PH, Alegria-Barrero E, Mario CD. Difficulties with horizontal aortic root in transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2012; 81:630-5. [DOI: 10.1002/ccd.24378] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 02/17/2012] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Carlo Di Mario
- Cardiovascular Biomedical Research Unit; Royal Brompton Hospital; London; United Kingdom
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29
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Modine T, Sudre A, Delhaye C, Fayad G, Lemesle G, Collet F, Koussa M. Transcutaneous Aortic Valve Implantation Using the Left Carotid Access: Feasibility and Early Clinical Outcomes. Ann Thorac Surg 2012; 93:1489-94. [DOI: 10.1016/j.athoracsur.2012.01.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/06/2012] [Accepted: 01/11/2012] [Indexed: 10/28/2022]
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30
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Chan PH, Alegria-Barrero E, Patterson T, Davies S, Di Mario C, Franzen OW, Moat N. Successful dual-valve transcatheter therapy for severe aortic stenosis and mitral regurgitation. Int J Cardiol 2012; 157:e35-7. [DOI: 10.1016/j.ijcard.2011.09.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 09/17/2011] [Indexed: 10/16/2022]
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Abstract
Surgical replacement of aortic valves is the gold standard for therapy of high grade aortic valve stenosis. However, the changes in demography confront the responsible medical discipline with an increasingly higher risk profile of patients which necessitates the development of new less invasive alternative forms of treatment for the surgical therapy of aortic valve stenosis. This developmental process has progressed from mini-thoracotomy to transcatheter aortic valve implantation (TAVI). The TAVI procedure is a new therapeutic option for treatment of patients with high grade aortic valve stenosis and high perioperative morbidity and mortality risks with conventional aortic valve replacement. Because TAVI can be carried out while the heart is still beating and without a sternotomy or heart-lung maschine, this procedure is particularly suitable for elderly multimorbid patients and/or patients with previous cardiac surgery. The initial results of large prospective multicenter studies underline the value of TAVI in the modern treatment of high risk patients with symptomatic aortic valve stenosis. In addition to an understanding of the surgical procedure, anesthetists must have precise knowledge of the perioperative anesthesia management and possible complications of the procedure.
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32
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Asgar AW, Bonan R. Transcatheter Aortic Valve Implantation: Experience with the CoreValve Device. Interv Cardiol Clin 2012; 1:27-36. [PMID: 28582065 DOI: 10.1016/j.iccl.2011.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The field of transcatheter aortic valve implantation has been rapidly evolving. The Medtronic CoreValve first emerged on the landscape in 2004 with initial first human studies, and it is currently being studied in the Pivotal US trial. This article details the current experience with the self-expanding aortic valve with a focus on clinical results and ongoing challenges.
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Affiliation(s)
- Anita W Asgar
- Montreal Heart Institute, 5000 Belanger, Montreal H1T1C8, Quebec, Canada
| | - Raoul Bonan
- Montreal Heart Institute, 5000 Belanger, Montreal H1T1C8, Quebec, Canada.
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Cioni M, Taramasso M, Giacomini A, Montorfano M, Latib A, Colombo A, Alfieri O, Maisano F. Transaxillary Approach Short- and Mid-Term Results in a Single-Center Experience. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Matteo Montorfano
- Interventional Cardiology Department, San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Department, San Raffaele University Hospital, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Department, San Raffaele University Hospital, Milan, Italy
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Transaxillary Approach Short- and Mid-Term Results in a Single-Center Experience. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011; 6:361-5. [DOI: 10.1097/imi.0b013e318248e9ed] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective Transcatheter aortic valve implantation (TAVI) is increasingly accepted as an alternative procedure in patients with severe, symptomatic aortic stenosis and high risk for surgical aortic valve replacement. Transfemoral (TF) approach is the first option when feasible, but in case of peripheral vascular disease this approach is precluded. In our institution, for this kind of patients we considered transaxillary (TAx) approach as second choice and transapical (TAp) or transaortic (TAa) as last routes. This study describes short- and mid-term morbidity and mortality for TAx approach. Methods From November 2007 to March 2011, 284 patients underwent TAVI at our site; 229 treated by TF approach, 22 TAp, 2 TAa, and 31 TAx. Four patients were treated with an Edwards Sapien valve (Edwards Lifesciences, Inc., Irvine, CA USA) with TAx approach and 27 with CoreValve Revalving System (Medtronic Inc., Minneapolis, MN USA). TAx TAVI was performed in cath-laboratory with local anesthesia and mild sedation by a multispeciality valve team. We analyzed major adverse cardiac and cerebrovascular events, major adverse valve-related events, vascular complications, and 30 days and 6 months mortality. Results The procedural success rate (successful implantation of the device without intraprocedural mortality or need to conversion to open heart surgery) was 96.8% (30/31). Major adverse valve-related events were 12.9% (4/31). 30-day mortality was 6.4% (2/31) and actuarial survival at 6 months was 82.95% ± 7.96%. In one patient, procedure was converted to a TF CoreValve in emergency for hemodynamic instability after valvuloplasty due to severe difficulty to introduce the Edwards valve in the subclavian artery. Conclusions TAx approach is a feasible and technically simple procedure with encouraging results considering morbidity and mortality at short- and mid-term follow-up. TAx is a valid solution in patients with contraindications to TF approach and it is an alternative approach potentially less invasive than TAp or TAa.
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35
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Přímá transaortální implantace chlopně do aortální pozice u nemocného po chirurgické revaskularizaci myokardu. COR ET VASA 2011. [DOI: 10.33678/cor.2011.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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