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Galeone A, Perrone F, Pesarini G, Ribichini FL, Di Gaetano R, Luciani GB, Onorati F. Ten-Year Experience with a Transapical Approach for Transcatheter Aortic and Mitral Valve Implantation. J Cardiovasc Dev Dis 2024; 11:201. [PMID: 39057621 PMCID: PMC11277261 DOI: 10.3390/jcdd11070201] [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: 06/16/2024] [Revised: 06/23/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The transfemoral approach represents the optimal access for TAVI due to its low invasiveness; however, up to 10-15% of TAVI candidates are considered unsuitable for femoral access because of significant peripheral vascular disease and need alternative access. METHODS This is a single-center retrospective observational study including all consecutive adult patients undergoing transcatheter procedures through a TA approach from March 2015 to April 2024. RESULTS 213 patients underwent transcatheter aortic or mitral valve implantation through a TA approach and were enrolled in this study. The mean age of the patients was 79.5 ± 5.7 years, and 54% of the patients were males. The mean Euroscore II was 7.9 ± 6.4%. One-third of the patients had previous cardiac surgery. The overall mean survival time was 5.3 ± 0.3 years. Nine (4%) patients developed infective endocarditis (IE) during the follow-up. CONCLUSIONS The transapical approach for transcatheter procedures is a safe and effective procedure for patients unsuitable for TF access with low periprocedural mortality and a low rate of post-procedural complications when performed by experienced surgeons and cardiologists.
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Affiliation(s)
- Antonella Galeone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Fabiola Perrone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
| | | | - Renato Di Gaetano
- Department of Cardiology, Azienda Sanitaria dell’Alto Adige, 39100 Bolzano, Italy
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Francesco Onorati
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
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Appa H, Park K, Bezuidenhout D, van Breda B, de Jongh B, de Villiers J, Chacko R, Scherman J, Ofoegbu C, Swanevelder J, Cousins M, Human P, Smith R, Vogt F, Podesser BK, Schmitz C, Conradi L, Treede H, Schröfel H, Fischlein T, Grabenwöger M, Luo X, Coombes H, Matskeplishvili S, Williams DF, Zilla P. The Technological Basis of a Balloon-Expandable TAVR System: Non-occlusive Deployment, Anchorage in the Absence of Calcification and Polymer Leaflets. Front Cardiovasc Med 2022; 9:791949. [PMID: 35310972 PMCID: PMC8928444 DOI: 10.3389/fcvm.2022.791949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022] Open
Abstract
Leaflet durability and costs restrict contemporary trans-catheter aortic valve replacement (TAVR) largely to elderly patients in affluent countries. TAVR that are easily deployable, avoid secondary procedures and are also suitable for younger patients and non-calcific aortic regurgitation (AR) would significantly expand their global reach. Recognizing the reduced need for post-implantation pacemakers in balloon-expandable (BE) TAVR and the recent advances with potentially superior leaflet materials, a trans-catheter BE-system was developed that allows tactile, non-occlusive deployment without rapid pacing, direct attachment of both bioprosthetic and polymer leaflets onto a shape-stabilized scallop and anchorage achieved by plastic deformation even in the absence of calcification. Three sizes were developed from nickel-cobalt-chromium MP35N alloy tubes: Small/23 mm, Medium/26 mm and Large/29 mm. Crimp-diameters of valves with both bioprosthetic (sandwich-crosslinked decellularized pericardium) and polymer leaflets (triblock polyurethane combining siloxane and carbonate segments) match those of modern clinically used BE TAVR. Balloon expansion favors the wing-structures of the stent thereby creating supra-annular anchors whose diameter exceeds the outer diameter at the waist level by a quarter. In the pulse duplicator, polymer and bioprosthetic TAVR showed equivalent fluid dynamics with excellent EOA, pressure gradients and regurgitation volumes. Post-deployment fatigue resistance surpassed ISO requirements. The radial force of the helical deployment balloon at different filling pressures resulted in a fully developed anchorage profile of the valves from two thirds of their maximum deployment diameter onwards. By combining a unique balloon-expandable TAVR system that also caters for non-calcific AR with polymer leaflets, a powerful, potentially disruptive technology for heart valve disease has been incorporated into a TAVR that addresses global needs. While fulfilling key prerequisites for expanding the scope of TAVR to the vast number of patients of low- to middle income countries living with rheumatic heart disease the system may eventually also bring hope to patients of high-income countries presently excluded from TAVR for being too young.
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Affiliation(s)
- Harish Appa
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Kenneth Park
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Deon Bezuidenhout
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Braden van Breda
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Bruce de Jongh
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Jandré de Villiers
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Reno Chacko
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Jacques Scherman
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Chima Ofoegbu
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Justiaan Swanevelder
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael Cousins
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Paul Human
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Robin Smith
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | - Ferdinand Vogt
- Deparment of Cardiac Surgery, Artemed Clinic Munich South, Munich, Germany
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Bruno K. Podesser
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Christoph Schmitz
- Auto Tissue Berlin, Berlin, Germany
- Department of Cardiac Surgery, University of Munich, Munich, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Hospital, Mainz, Germany
| | - Holger Schröfel
- Department of Cardiovascular Surgery, University Heart Center, Freiburg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Vienna North Hospital, Vienna, Austria
| | - Xinjin Luo
- Department of Cardiac Sugery, Fu Wai Hospital, Peking Union Medical College, Beijing, China
| | - Heather Coombes
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
| | | | - David F. Williams
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
- Wake Forest Institute of Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Peter Zilla
- Strait Access Technologies (SAT), University of Cape Town, Cape Town, South Africa
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
- Chris Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
- Cape Heart Centre, University of Cape Town, Cape Town, South Africa
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Oh S, Kim JH, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Ahn Y, Jeong MH, Lee KS. Transcatheter aortic valve replacement via a transsubclavian approach in a patient with severe aortic stenosis who had previously undergone kidney transplantation: A case report. Medicine (Baltimore) 2021; 100:e27210. [PMID: 34596118 PMCID: PMC8483856 DOI: 10.1097/md.0000000000027210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/27/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Although the transfemoral approach is the gold standard for transcatheter aortic valve replacement (TAVR), it is not feasible in a considerable number of patients. We report a case of successful transsubclavian TAVR (TS-TAVR) in a patient with severe aortic stenosis (AS) who was ineligible for transfemoral TAVR because she was a kidney transplant recipient. PATIENT CONCERNS A 72-year-old Korean woman, who had previously undergone kidney transplantation in the right iliac fossa for end-stage kidney disease, was admitted to our center with dyspnea. Upon auscultation, grade IV systolic murmurs were detected in both upper sternal borders and the left lower sternal border, suggestive of valvular heart disease. DIAGNOSIS Two-dimensional transthoracic echocardiography revealed heavy calcification of the aortic valve with a high peak velocity (4.54 m/s) and mean pressure gradient (48.49 mm Hg), indicative of severe AS. INTERVENTIONS TS-TAVR was performed by a heart team comprised of interventional cardiologists, cardiac surgeons, and anesthesiologists. A self-expandable valve prosthesis (CoreValveTM Evolut RTM, Medtronic Inc., Minneapolis, MN) was successfully deployed via the left subclavian artery. OUTCOMES Post-TAVR 2-dimensional transthoracic echocardiography demonstrated a well-functioning valve with mild paravalvular leakage. The peak velocity had declined from 4.54 m/s to 2.22 to 2.24 m/s, and the mean pressure gradient had declined from 48.49 to 8.57-9.61 mmHg. The patient was discharged successfully and uneventfully. LESSONS Because kidney transplant recipients with severe AS are considered poor candidates for transfemoral TAVR, TS-TAVR is a suitable alternative to consider.
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Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kyo Seon Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, Korea
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Veulemans V, Hellhammer K, Borhan Azad A, Goh S, Drake C, Maier O, Piayda K, Polzin A, Mehdiani A, Jung C, Westenfeld R, Kelm M, Lichtenberg A, Zeus T. Short- and Mid-Term Outcomes in Patients Deemed Inoperable Undergoing Transapical and Transfemoral TAVR with an STS-PROM below Four Percent. J Clin Med 2021; 10:jcm10132993. [PMID: 34279476 PMCID: PMC8267718 DOI: 10.3390/jcm10132993] [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] [Received: 05/15/2021] [Revised: 06/23/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022] Open
Abstract
Transapical (TA) TAVR is known to be associated with increased mortality and vascular complications compared with transfemoral (TF) TAVR in high-risk and inoperable patients. However, safe alternative access methods remain crucial. We aimed to (1) evaluate the 30-day and 1-year outcomes comparing TA and TF TAVR in patients with an STS-PROM of <4% deemed inoperable and (2) determine dependent and independent predictors for all-cause one-year mortality. Data were collected from a single-center registry consisting of 340 eligible patients. One-to-one propensity score matching was performed (n = 50 TA, n = 50 TF). Primary endpoints were all-cause mortality, stroke, and major bleeding. Predictors for all-cause one-year mortality were evaluated. Thirty-day mortality (TF vs. TA: 0.0% vs. 4.0%; p = 0.153) was comparable in both cohorts. One-year all-cause mortality was twice as high in TA patients (TF vs. TA: 10.0% vs. 20.0%, p logrank = 0.165, HR 2.10). Cerebrovascular events and major bleeding during one-year follow-up were similar. The multivariate analysis identified hemoglobin <12 g/dL at admission and dual antiplatelet therapy as strong predictors for one-year mortality. Although femoral access is the primary access with favorable 30-day and 1-year results, transapical access was successful for patients unsuitable for TF TAVR, showing acceptable short- and mid-term results in inoperable patients with low-risk profiles.
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Affiliation(s)
- Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
- Correspondence: ; Tel.: +49-211-18800
| | - Katharina Hellhammer
- Cardiology and Vascular Medicine, Contilia Herz-und Gefäßzentrum, 45138 Essen, Germany;
| | - Armin Borhan Azad
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
| | - Shouheng Goh
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
| | - Christian Drake
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
| | - Oliver Maier
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
| | - Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
| | - Arash Mehdiani
- Division of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.M.); (A.L.)
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
- Cardiovascular Research Institute Düsseldorf (CARID), Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Artur Lichtenberg
- Division of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.M.); (A.L.)
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany; (A.B.A.); (S.G.); (C.D.); (O.M.); (K.P.); (A.P.); (C.J.); (R.W.); (M.K.); (T.Z.)
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Anesthesia Considerations for Transcatheter Mitral and Aortic Valve Procedures. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Brachial artery access for transcatheter aortic valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:124-125. [PMID: 33868431 PMCID: PMC8039932 DOI: 10.5114/aic.2021.104782] [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: 07/15/2020] [Accepted: 11/07/2020] [Indexed: 11/17/2022] Open
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Pour-Ghaz I, Raja J, Bayoumi M, Manolukas T, Khouzam RN, Ibebuogu UN. Transcatheter aortic valve replacement with a focus on transcarotid: a review of the current literature. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:420. [PMID: 31660319 DOI: 10.21037/atm.2019.07.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Valve replacement in high-risk patients with severe aortic stenosis has undergone a huge paradigm shift in the recent years in terms of procedural details and vascular access site for patients who have poor peripheral access. Carotid artery is one of the more promising access sites which has been proven to provide a good alternative site with comparable outcomes to transfemoral approach. In this manuscript, we will provide a review of the current literature on transaortic, transapical, transaxillary and transcarotid approaches to transcatheter aortic valve replacement (TAVR) while focusing on the transcarotid approach.
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Affiliation(s)
- Issa Pour-Ghaz
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joel Raja
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mahmoud Bayoumi
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Theodore Manolukas
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Madigan M, Atoui R. Non-transfemoral access sites for transcatheter aortic valve replacement. J Thorac Dis 2018; 10:4505-4515. [PMID: 30174904 DOI: 10.21037/jtd.2018.06.150] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transfemoral access is currently the standard and preferred access site for transcatheter aortic valve replacement (TAVR), though novel approaches are emerging to expand treatment options for the increasing numbers of patients with a contraindication for the traditional route. Previous publications have provided comparisons between two TAVR access sites, primarily transfemoral versus one of the novel approaches, while others have compared three or four novel approaches. The aim of this report is to provide a comprehensive summary of publications that analyse and compare the six non-transfemoral access sites currently described in the literature. These include the transapical, transaortic, axillary/subclavian, brachiocephalic, transcarotid, and transcaval approaches. Though there remains little consensus as to the superiority or non-inferiority of TAVR approaches, and there has yet to be randomized clinical trials to support published findings, with careful patient and procedural selection, outcomes for novel approaches have been reported to be comparable to standard transfemoral access when performed by skilled physicians. As such, choice of procedure is primarily based on registry data and the judgement of surgical teams as to which approach is best in each individual case. As TAVR continues to be an increasingly widespread treatment, search for the optimal access site will grow, and focus should be placed on the importance of educating surgeons as to all possible approaches so they may review and chose the most appropriate technique for a given patient.
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Affiliation(s)
- Mariah Madigan
- Division of Cardiac Surgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Rony Atoui
- Division of Cardiac Surgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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Does a Higher Society of Thoracic Surgeons Score Predict Outcomes in Transfemoral and Alternative Access Transcatheter Aortic Valve Replacement? Ann Thorac Surg 2016; 102:474-82. [PMID: 27209615 DOI: 10.1016/j.athoracsur.2016.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 02/01/2016] [Accepted: 02/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) is often associated with worse outcomes than TF TAVR. We investigated the relationship between increasing Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score and observed mortality and morbidity in TF and non-TF TAVR groups. METHODS We reviewed 595 patients undergoing TAVR at Emory Healthcare between 2007 and 2014. Clinical outcomes were reported for 337 TF patients (57%) and 258 non-TF patients (43%). We created 3 STS PROM score subgroups: <8%, 8%-15%, and >15%. A composite outcome of postoperative events was defined as death, stroke, renal failure, vascular complications, or new pacemaker implantation. RESULTS TF patients were older (82.4 ± 8.0 vs 80.8 ± 8.7 years, p = 0.02), whereas the STS PROM was higher in non-TF patients (10.5% ± 5.3% vs 11.7% ± 5.7%, p = 0.01). Observed/expected mortality was less than 1.0 in all groups. The rate of the composite outcome did not differ between STS PROM subgroups in TF (p = 0.68) or non-TF TAVR (p = 0.27). One-year mortality was higher for patients with STS PROM >8% in the non-TF group; however, this difference was not observed in TF patients (p = 0.40). CONCLUSIONS As expected, non-TF patients were at a higher risk than TF patients for procedural morbidity and death. Although no differences were observed in 30-day deaths or morbidity in different STS PROM subgroups, those undergoing non-TF TAVR at a higher STS PROM (>8%) had higher 1-year mortality. When applicable, TF TAVR remains the procedure of choice in high- or extreme-risk patients undergoing TAVR.
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10
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Thourani VH, Jensen HA, Babaliaros V, Suri R, Vemulapalli S, Dai D, Brennan JM, Rumsfeld J, Edwards F, Tuzcu EM, Svensson L, Szeto WY, Herrmann H, Kirtane AJ, Kodali S, Cohen DJ, Lerakis S, Devireddy C, Sarin E, Carroll J, Holmes D, Grover FL, Williams M, Maniar H, Shahian D, Mack M. Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States. Ann Thorac Surg 2015; 100:1718-26; discussion 1726-7. [DOI: 10.1016/j.athoracsur.2015.05.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/24/2015] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
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