1
|
Ahmed A, Faisaluddin M, Elgendy IY. Association between lower extremity peripheral arterial disease and in-hospital outcomes among patients undergoing trans-catheter mitral valve edge-to-edge repair. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 37:100355. [PMID: 38510508 PMCID: PMC10945918 DOI: 10.1016/j.ahjo.2023.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 03/22/2024]
Affiliation(s)
- Asmaa Ahmed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States of America
| | - Mohammed Faisaluddin
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States of America
| | - Islam Y. Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, KY, United States of America
| |
Collapse
|
2
|
Bennes O, Souteyrand G, Cambier S, Motreff P, Riocreux C, Eljezi V, Lahaye C, Eschalier R, Innorta A, Combaret N. Transfemoral versus trans-subclavian access in transcatheter aortic valve implantation using self-expandable valve: A propensity-matched comparison. Arch Cardiovasc Dis 2023; 116:555-562. [PMID: 37940389 DOI: 10.1016/j.acvd.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation is unfeasible for 10-15% of patients using the conventional transfemoral approach. Other alternative approaches, such as the subclavian approach, have emerged, with no clear recommendation indicating the superiority of one technique over another. AIM To compare the 1-month mortality and postprocedural outcomes of patients undergoing transcatheter aortic valve implantation using a self-expandable valve via transfemoral and subclavian access. METHODS This was a retrospective single-centre study including 1496 patients who underwent transcatheter aortic valve implantation between January 2016 and December 2020 at Clermont-Ferrand University Hospital, France. Propensity score matching was used to compare transfemoral and subclavian access. RESULTS After building two propensity score-matched groups of 221 patients each with either access route (total n=442), baseline characteristics were similar. The procedure duration was significantly longer in the subclavian access group (53 [45-64] versus 60 [51-72] minutes; P<0.001), but with a lower amount of contrast agent (138 [118-165] versus 123 [105-150] mL; P<0.001), fluoroscopy time (11.2 [9-14] versus 9.9 [7-12] minutes; P<0.001) and radiation dose (397 [264-620] versus 321 [217-485] mGy; P<0.001). No significant difference was observed concerning 1-month mortality (odds ratio 1.62, 95% confidence interval 0.52-5.03; P=0.39) or periprocedural complications. Follow-up at 1 year confirmed no difference in longer-term mortality (hazard ratio 0.78, 95% confidence interval 0.52-5.03; P=0.43). CONCLUSIONS The subclavian approach provides similar results to the transfemoral approach in terms of mortality, efficacy and safety; it is a reasonable and effective alternative when the reference transfemoral approach is impossible or seems complex.
Collapse
Affiliation(s)
- Olivier Bennes
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France.
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Sébastien Cambier
- Delegation to Clinical Research and Innovation, Biostatistics Unit, CHU Clermont-Ferrand, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Clément Riocreux
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Vedat Eljezi
- Department of Perioperative Medicine, CHU Clermont-Ferrand, CNRS, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Clément Lahaye
- Department of Geriatrics, CHU Clermont-Ferrand, CNRS, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Andréa Innorta
- Department of Cardiovascular Surgery, CHU Clermont-Ferrand, CNRS, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Nicolas Combaret
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| |
Collapse
|
3
|
Bansal K, Soni A, Shah M, Kosinski AS, Gilani F, Khera S, Vemulapalli S, Elmariah S, Kolte D. Association Between Polyvascular Disease and Transcatheter Aortic Valve Replacement Outcomes: Insights From the STS/ACC TVT Registry. Circ Cardiovasc Interv 2023; 16:e013578. [PMID: 37870587 DOI: 10.1161/circinterventions.123.013578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Atherosclerotic cardiovascular disease is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Polyvascular disease (PVD), defined as involvement of ≥2 vascular beds (VBs), that is, coronary, cerebrovascular, or peripheral, portends a poor prognosis in patients with atherosclerotic cardiovascular disease; however, data on the association of PVD with outcomes of patients undergoing TAVR are limited. METHODS The Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy Registry was analyzed to identify patients who underwent TAVR from November 2011 to March 2022. The exposure of interest was PVD. The primary outcome was all-cause mortality. Secondary outcomes included major vascular complications, major/life-threatening bleeding, myocardial infarction, transient ischemic attack/stroke, and valve- and non-valve-related readmissions. Outcomes were assessed at 30 days and 1 year. RESULTS Of 443 790 patients who underwent TAVR, PVD was present in 150 823 (34.0%; 111 425 [25.1%] with 2VB-PVD and 39 398 [8.9%] with 3VB-PVD). On multivariable analysis, PVD was associated with increased all-cause mortality at 1 year (hazard ratio, 1.17 [95% CI, 1.14-1.20]). There was an incremental increase in 1-year mortality with an increasing number of VBs involved (no PVD [reference]; 2VB-PVD: hazard ratio, 1.12 [95% CI, 1.09-1.15]: and 3VB-PVD: hazard ratio, 1.31 [95% CI, 1.26-1.36]). Patients with versus without PVD had higher rates of major vascular complications, major/life-threatening bleeding, transient ischemic attack/stroke, and non-valve-related readmissions at 30 days and 1 year. CONCLUSIONS PVD is associated with worse outcomes after TAVR, and the risk is highest in patients with 3VB-PVD.
Collapse
Affiliation(s)
- Kannu Bansal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (K.B., A.S.)
| | - Aakriti Soni
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (K.B., A.S.)
| | - Miloni Shah
- Duke Clinical Research Institute, Durham, NC (M.S., A.S.K.)
| | | | - Fahad Gilani
- Division of Cardiovascular Medicine, Catholic Medical Center, Manchester, NH (F.G.)
| | - Sahil Khera
- Division of Interventional Cardiology, Mount Sinai Hospital, New York, NY (S.K.)
| | - Sreekanth Vemulapalli
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (S.V.)
- Division of Cardiology, Duke University Medical Center, Durham, NC (S.V.)
| | - Sammy Elmariah
- Division of Cardiology, University of California, San Francisco (S.E.)
| | - Dhaval Kolte
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston (D.K.)
| |
Collapse
|
4
|
Isogai T, Agrawal A, Shekhar S, Spilias N, Puri R, Krishnaswamy A, Unai S, Yun JJ, Kapadia SR, Reed GW. Comparison of Outcomes Following Transcatheter Aortic Valve Replacement Requiring Peripheral Vascular Intervention or Alternative Access. J Am Heart Assoc 2023:e028878. [PMID: 37301759 DOI: 10.1161/jaha.122.028878] [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: 11/17/2022] [Accepted: 05/01/2023] [Indexed: 06/12/2023]
Abstract
Background Peripheral vascular intervention (PVI) is occasionally required to facilitate delivery system insertion or to treat vascular complications during transfemoral transcatheter aortic valve replacement (TF-TAVR). However, the impact of PVI on outcomes is not well understood. Therefore, we aimed to compare outcomes between TF-TAVR with versus without PVI and between TF-TAVR with PVI versus non-TF-TAVR. Methods and Results We retrospectively reviewed 2386 patients who underwent TAVR with a balloon-expandable valve at a single institution from 2016 to 2020. The primary outcomes were death and major adverse cardiac/cerebrovascular event (MACCE), defined as death, myocardial infarction, or stroke. Of 2246 TF-TAVR recipients, 136 (6.1%) required PVI (89% bailout treatment). During follow-up (median 23.0 months), there were no significant differences between TF-TAVR with and without PVI in death (15.4% versus 20.7%; adjusted HR [aHR], 0.96 [95% CI, 0.58-1.58]) or MACCE (16.9% versus 23.0%; aHR, 0.84 [95% CI, 0.52-1.36]). However, compared with non-TF-TAVR (n=140), TF-TAVR with PVI carried significantly lower rates of death (15.4% versus 40.7%; aHR, 0.42 [95% CI, 0.24-0.75]) and MACCE (16.9% versus 45.0%; aHR, 0.40 [95% CI, 0.23-0.68]). Landmark analyses demonstrated lower outcome rates following TF-TAVR with PVI than non-TF-TAVR both within 60 days (death 0.7% versus 5.7%, P=0.019; MACCE 0.7% versus 9.3%; P=0.001) and thereafter (death 15.0% versus 38.9%, P=0.014; MACCE 16.5% versus 41.3%, P=0.013). Conclusions The need for PVI during TF-TAVR is not uncommon, mainly due to the bailout treatment for vascular complications. PVI is not associated with worse outcomes in TF-TAVR recipients. Even when PVI is required, TF-TAVR is associated with better short- and intermediate-term outcomes than non-TF-TAVR.
Collapse
Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Nikolaos Spilias
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Rishi Puri
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - James J Yun
- Department of Thoracic and Cardiovascular Surgery Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Grant W Reed
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| |
Collapse
|
5
|
Magruder JT, Holst KA, Thourani VH. The Future of Alternative Access Approaches for TAVR. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:229-231. [PMID: 37309849 DOI: 10.1177/15569845231180870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- J Trent Magruder
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Athens, GA, USA
| | - Kimberly A Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| |
Collapse
|
6
|
Palmerini T, Saia F, Kim WK, Renker M, Iadanza A, Fineschi M, Bruno AG, Ghetti G, Vanhaverbeke M, Søndergaard L, De Backer O, Romagnoli E, Burzotta F, Trani C, Adrichem R, Van Mieghem NM, Nardi E, Chietera F, Orzalkiewicz M, Tomii D, Pilgrim T, Aranzulla TC, Musumeci G, Adam M, Meertens MM, Taglieri N, Marrozzini C, Alvarez Covarrubias HA, Joner M, Nardi G, Di Muro FM, Di Mario C, Loretz L, Toggweiler S, Gallitto E, Gargiulo M, Testa L, Bedogni F, Berti S, Ancona MB, Montorfano M, Leone A, Savini C, Pacini D, Gmeiner J, Braun D, Nerla R, Castriota F, De Carlo M, Petronio AS, Barbanti M, Costa G, Tamburino C, Leone PP, Reimers B, Stefanini G, Sudo M, Nickenig G, Piva T, Scotti A, Latib A, Vercellino M, Porto I, Codner P, Kornowski R, Bartorelli AL, Tarantini G, Fraccaro C, Abdel-Wahab M, Grube E, Galié N, Stone GW. Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR: The Hostile Registry. JACC Cardiovasc Interv 2023; 16:396-411. [PMID: 36858659 DOI: 10.1016/j.jcin.2022.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined. OBJECTIVES This study sought to compare clinical outcomes with transfemoral access (TFA), transthoracic access (TTA), and nonthoracic transalternative access (TAA) in TAVR patients with severe PAD. METHODS Patients with PAD and hostile femoral access (TFA impossible, or possible only after percutaneous treatment) undergoing TAVR at 28 international centers were included in this registry. The primary endpoint was the propensity-adjusted risk of 30-day major adverse events (MAE) defined as the composite of all-cause mortality, stroke/transient ischemic attack (TIA), or main access site-related Valve Academic Research Consortium 3 major vascular complications. Outcomes were also stratified according to the severity of PAD using a novel risk score (Hostile score). RESULTS Among the 1,707 patients included in the registry, 518 (30.3%) underwent TAVR with TFA after percutaneous treatment, 642 (37.6%) with TTA, and 547 (32.0%) with TAA (mostly transaxillary). Compared with TTA, both TFA (adjusted HR: 0.58; 95% CI: 0.45-0.75) and TAA (adjusted HR: 0.60; 95% CI: 0.47-0.78) were associated with lower 30-day rates of MAE, driven by fewer access site-related complications. Composite risks at 1 year were also lower with TFA and TAA compared with TTA. TFA compared with TAA was associated with lower 1-year risk of stroke/TIA (adjusted HR: 0.49; 95% CI: 0.24-0.98), a finding confined to patients with low Hostile scores (Pinteraction = 0.049). CONCLUSIONS Among patients with PAD undergoing TAVR, both TFA and TAA were associated with lower 30-day and 1-year rates of MAE compared with TTA, but 1-year stroke/TIA rates were higher with TAA compared with TFA.
Collapse
Affiliation(s)
- Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy.
| | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | | | | | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Massimo Fineschi
- UOSA Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonio Giulio Bruno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Maarten Vanhaverbeke
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Enrico Romagnoli
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rik Adrichem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Chietera
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Daijiro Tomii
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Matti Adam
- Klinik III für Innere Medizin - Kardiologie, Pneumologie und Internistische Intensivmedizin, University Hospital Cologne - Heart Center, Cologne, Germany
| | - Max M Meertens
- Klinik III für Innere Medizin - Kardiologie, Pneumologie und Internistische Intensivmedizin, University Hospital Cologne - Heart Center, Cologne, Germany
| | - Nevio Taglieri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Hector Alfonso Alvarez Covarrubias
- German Heart Centre Munich, Munich, Germany; Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Institutio Mexicano de Seguro Social, Mexico City, Mexico
| | | | | | | | | | - Lucca Loretz
- Cardiology, Heart Center Lucerne, Lucerne, Switzerland
| | | | - Enrico Gallitto
- Vascular Surgery, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Francesco Bedogni
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Sergio Berti
- Unit of Diagnostic and Interventional Cardiology, C.N.R. Reg. Toscana G. Monasterio Foundation, Ospedale del Cuore, Massa, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Leone
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Savini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jonas Gmeiner
- Department of Medicine I, University Hospital Munich, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany
| | - Daniel Braun
- Department of Medicine I, University Hospital Munich, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | - Marco De Carlo
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | | | - Bernhard Reimers
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Stefanini
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Mitsumasa Sudo
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Tommaso Piva
- Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I - GM Lancisi, Torette, Italy
| | - Andrea Scotti
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Matteo Vercellino
- Cardiology Unit, Cardio-Thoraco Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Cardiology Unit, Cardio-Thoraco Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Eberhard Grube
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Nazzareno Galié
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
7
|
Abusnina W, Machanahalli Balakrishna A, Ismayl M, Latif A, Reda Mostafa M, Al-abdouh A, Junaid Ahsan M, Radaideh Q, Haddad TM, Goldsweig AM, Ben-Dor I, Mamas MA, Dahal K. Comparison of Transfemoral versus Transsubclavian/Transaxillary access for transcatheter aortic valve replacement: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2022; 43:101156. [PMCID: PMC9718962 DOI: 10.1016/j.ijcha.2022.101156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Safe alternative access, that represents about 15 % of TAVR cases, remains important for patients without adequate transfemoral access. We aimed to perform a systematic review and meta-analysis of studies comparing transfemoral (TF) access versus transsubclavian or transaxillary (TSc/TAx) access in patients undergoing TAVR. We searched PubMed, Cochrane CENTRAL Register, EMBASE, Web of Science, Google Scholar and ClinicalTrials.gov (inception through May 24, 2022) for studies comparing (TF) to (TSc/TAx) access for TAVR. A total of 21 studies with 75,995 unique patients who underwent TAVR (73,203 transfemoral and 2,792 TSc/TAx) were included in the analysis. There was no difference in the risk of in-hospital and 30-day all-cause mortality between the two groups (RR 0.64, 95 % CI 0.36–1.13, P = 0.12) and (RR 0.95, 95 % CI 0.64–1.41, P = 0.81), while 1-year mortality was significantly lower in the TF TAVR group (RR 0.79, 95 % CI 0.67–0.93, P = 0.005). No significant differences in major bleeding (RR 0.82, 95 % CI 0.65–1.03, P = 0.09), major vascular complications (RR 1.14, 95 % CI 0.75–1.72, P = 0.53), and stroke (RR 0.66, 95 % CI 0.42–1.02, P = 0.06) were observed. In patients undergoing TAVR, TF access is associated with significantly lower 1-year mortality compared to TSc/TAx access without differences in major bleeding, major vascular complications and stroke. While TF is the preferred approach for TAVR, TSc/TAx is a safe alternative approach. Future studies should confirm these findings, preferably in a randomized setting.
Collapse
Key Words
- tavr
- tavi
- access site
- subclavian access
- axillary access
- femoral access
- aki, acute kidney injury
- as, aortic stenosis
- ci, confidence interval
- mi, myocardial infarction
- rr, risk ratio
- tavr, transcatheter aortic valve replacement
- tf, transfemoral
- tsc, transsubclavian
- tax, transaxillary
- tc, transcarotid
Collapse
Affiliation(s)
- Waiel Abusnina
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | | | - Mahmoud Ismayl
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Azka Latif
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | | | - Ahmad Al-abdouh
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Qais Radaideh
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Toufik M. Haddad
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Andrew M. Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, UK
| | - Khagendra Dahal
- Division of Cardiology, Creighton University School of Medicine, NE, USA,Corresponding author
| |
Collapse
|
8
|
Wong CK, Chiu ACHO, Chan KYE, Sze SY, Tam FCC, Un KC, Lam SCC, Tse HF. Advances in technology and techniques for transcatheter aortic valve replacement with concomitant peripheral arterial disease. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:959249. [PMID: 36062263 PMCID: PMC9433652 DOI: 10.3389/fmedt.2022.959249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
Aortic stenosis (AS) is a prevalent disease affecting 3.7% of the adult population aged 65 or above. In the past, surgical aortic valve replacement (SAVR) was the only definitive therapy available for the treatment of severe AS. Owing to the invasive nature of open-heart surgery, patients with advanced age and frailty could not benefit from SAVR. The advent of transcatheter aortic valve replacement (TAVR) in the past decade has offered an alternative treatment option for patients with severe AS, particularly those who are deemed to have high surgical risks. Nevertheless, a large proportion of patients also have concomitant peripheral arterial disease (PAD), which increases the risk of peri-procedural vascular complication, and precludes the possibility of transfemoral TAVR owing to inadequate luminal size for delivery system deployment. In this review, the prevalence and outcome of TAVR patients with PAD will be discussed. Furthermore, novel technologies and techniques that enable TAVR to be safely performed using transfemoral or alternative access in patients with severe PAD will be reviewed.
Collapse
|
9
|
Lederman RJ, Babaliaros VC, Lisko JC, Rogers T, Mahoney P, Foerst JR, Depta JP, Muhammad KI, McCabe JM, Pop A, Khan JM, Bruce CG, Medranda GA, Wei JW, Binongo JN, Greenbaum AB. Transcaval Versus Transaxillary TAVR in Contemporary Practice: A Propensity-Weighted Analysis. JACC Cardiovasc Interv 2022; 15:965-975. [PMID: 35512920 PMCID: PMC9138050 DOI: 10.1016/j.jcin.2022.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to compare transcaval and transaxillary artery access for transcatheter aortic valve replacement (TAVR) at experienced medical centers in contemporary practice. BACKGROUND There are no systematic comparisons of transcaval and transaxillary TAVR access routes. METHODS Eight experienced centers contributed local data collected for the STS/ACC TVT Registry (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry) between 2017 and 2020. Outcomes after transcaval and axillary/subclavian (transaxillary) access were adjusted for baseline imbalances using doubly robust (inverse propensity weighting plus regression) estimation and compared. RESULTS Transcaval access was used in 238 procedures and transaxillary access in 106; for comparison, transfemoral access was used in 7,132 procedures. Risk profiles were higher among patients selected for nonfemoral access but similar among patients requiring transcaval and transaxillary access. Stroke and transient ischemic attack were 5-fold less common after transcaval than transaxillary access (2.5% vs 13.2%; OR: 0.20; 95% CI: 0.06-0.72; P = 0.014) compared with transfemoral access (1.7%). Major and life-threatening bleeding (Valve Academic Research Consortium 3 ≥ type 2) were comparable (10.0% vs 13.2%; OR: 0.66; 95% CI: 0.26-1.66; P = 0.38) compared with transfemoral access (3.5%), as was blood transfusion (19.3% vs 21.7%; OR: 1.07; 95% CI: 0.49-2.33; P = 0.87) compared with transfemoral access (7.1%). Vascular complications, intensive care unit and hospital length of stay, and survival were similar between transcaval and transaxillary access. More patients were discharged directly home and without stroke or transient ischemic attack after transcaval than transaxillary access (87.8% vs 62.3%; OR: 5.19; 95% CI: 2.45-11.0; P < 0.001) compared with transfemoral access (90.3%). CONCLUSIONS Patients undergoing transcaval TAVR had lower rates of stroke and similar bleeding compared with transaxillary access in a contemporary experience from 8 US centers. Both approaches had more complications than transfemoral access. Transcaval TAVR access may offer an attractive option.
Collapse
Affiliation(s)
- Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | - Vasilis C Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C Lisko
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Paul Mahoney
- Division of Cardiology, The Sentara Heart Center, Norfolk, Virginia, USA
| | - Jason R Foerst
- Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Jeremiah P Depta
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | | | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Andrei Pop
- AMITA Health Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jane W Wei
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jose N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Adam B Greenbaum
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA. https://twitter.com/AdamGreenbaumMD
| |
Collapse
|
10
|
Reed GW, Puri R, Kumar A. Searching for closure after transfemoral TAVR. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 37:41-42. [DOI: 10.1016/j.carrev.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
|
11
|
Neumann FJ, Schröfel H. Peripheral Vascular Intervention in Patients With Transcatheter Aortic Valve Replacement: Friend and Foe. JACC Cardiovasc Interv 2021; 14:2581-2583. [PMID: 34774480 DOI: 10.1016/j.jcin.2021.09.007] [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: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center, Medical Center - University of Freiburg, Bad Krozingen, Germany.
| | - Holger Schröfel
- Department of Cardiovascular Surgery, University Heart Center, Medical Center - University of Freiburg, Bad Krozingen, Germany
| |
Collapse
|