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Lutz K, Asturias KM, Garg J, Poudyal A, Lantz G, Golwala H, Doberne J, Politano A, Song HK, Zahr F. Alternative Access for TAVR: Choosing the Right Pathway. J Clin Med 2024; 13:3386. [PMID: 38929915 PMCID: PMC11203974 DOI: 10.3390/jcm13123386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment option for patients with severe aortic stenosis regardless of surgical risk, particularly in those with a high and prohibitive risk. Since the advent of TAVR, transfemoral access has been the standard of care. However, given comorbidities and anatomical limitations, a proportion of patients are not good candidates for a transfemoral approach. Alternative access, including transapical, transaortic, transaxillary, transsubclavian, transcarotid, and transcaval, can be considered. Each alternative access has advantages and disadvantages, so the vascular route should be tailored to the patient's characteristics. However, there is no standardized algorithm when choosing the optimal alternative vascular access. In this review, we analyzed the evolution and current evidence for the most common alternative access for TAVR and proposed an algorithm for choosing the optimal vascular access in this patient population.
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Affiliation(s)
- Katherine Lutz
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97201, USA; (K.L.); (K.M.A.); (A.P.); (H.G.)
| | - Karla M. Asturias
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97201, USA; (K.L.); (K.M.A.); (A.P.); (H.G.)
| | - Jasmine Garg
- Department of Medicine, Westchester Medical Center, Valhalla, NY 10595, USA;
| | - Abhushan Poudyal
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97201, USA; (K.L.); (K.M.A.); (A.P.); (H.G.)
| | - Gurion Lantz
- Division of Cadiothoracic Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97201, USA; (G.L.); (J.D.); (H.K.S.)
| | - Harsh Golwala
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97201, USA; (K.L.); (K.M.A.); (A.P.); (H.G.)
| | - Julie Doberne
- Division of Cadiothoracic Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97201, USA; (G.L.); (J.D.); (H.K.S.)
| | - Amani Politano
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97201, USA;
| | - Howard K. Song
- Division of Cadiothoracic Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97201, USA; (G.L.); (J.D.); (H.K.S.)
| | - Firas Zahr
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97201, USA; (K.L.); (K.M.A.); (A.P.); (H.G.)
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Alegre Cortés A, Bilbao Ares A, Pola Jiménez A, Abaurrea Díaz Y, Fernández Alonso S, Salvador Bravo M. Transcaval approach for aortic endoprosthesis insertion. A new anesthetic challenge. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00098-2. [PMID: 38801918 DOI: 10.1016/j.redare.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/14/2023] [Indexed: 05/29/2024]
Abstract
The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach. The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence. We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.
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Affiliation(s)
- A Alegre Cortés
- Servicio Anestesia y Reanimación, Hospital Universitario de Navarra, Pamplona, Spain.
| | - A Bilbao Ares
- Servicio Anestesia y Reanimación, Hospital Universitario de Navarra, Pamplona, Spain
| | - A Pola Jiménez
- Servicio Anestesia y Reanimación, Hospital Universitario de Navarra, Pamplona, Spain
| | - Y Abaurrea Díaz
- Servicio Anestesia y Reanimación, Hospital Universitario de Navarra, Pamplona, Spain
| | - S Fernández Alonso
- Servicio Cirugía Vascular y Angiología, Hospital Universitario de Navarra, Pamplona, Spain
| | - M Salvador Bravo
- Servicio Anestesia y Reanimación, Hospital Universitario de Navarra, Pamplona, Spain
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Antiochos P, Kirsch M, Monney P, Tzimas G, Meier D, Fournier S, Ferlay C, Nowacka A, Rancati V, Abellan C, Skalidis I, Muller O, Lu H. Transcaval versus Supra-Aortic Vascular Accesses for Transcatheter Aortic Valve Replacement: A Systematic Review with Meta-Analysis. J Clin Med 2024; 13:455. [PMID: 38256589 PMCID: PMC10816274 DOI: 10.3390/jcm13020455] [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: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
A growing body of evidence suggests that extrathoracic vascular accesses for transcatheter aortic valve replacement (TAVR) yield favorable outcomes and can be considered as primary alternatives when the gold-standard transfemoral access is contraindicated. Data comparing the transcaval (TCv) to supra-aortic (SAo) approaches (transcarotid, transsubclavian, and transaxillary) for TAVR are lacking. We aimed to compare the outcomes and safety of TCv and SAo accesses for TAVR as alternatives to transfemoral TAVR. A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all articles comparing TCv-TAVR against SAo-TAVR published until September 2023. Outcomes included in-hospital or 30-day all-cause mortality (ACM) and postoperative complications. A total of three studies with 318 TCv-TAVR and 179 SAo-TAVR patients were included. No statistically significant difference was found regarding in-hospital or 30-day ACM (relative risk [RR] 1.04, 95% confidence interval [CI] 0.47-2.34, p = 0.91), major bleeding, the need for blood transfusions, major vascular complications, and acute kidney injury. TCv-TAVR was associated with a non-statistically significant lower rate of neurovascular complications (RR 0.39, 95%CI 0.14-1.09, p = 0.07). These results suggest that both approaches may be considered as first-line alternatives to transfemoral TAVR, depending on local expertise and patients' anatomy. Additional data from long-term cohort studies are needed.
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Affiliation(s)
- Panagiotis Antiochos
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (P.M.); (G.T.); (D.M.); (S.F.); (C.F.); (I.S.); (O.M.)
| | - Matthias Kirsch
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (M.K.); (A.N.)
| | - Pierre Monney
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (P.M.); (G.T.); (D.M.); (S.F.); (C.F.); (I.S.); (O.M.)
| | - Georgios Tzimas
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (P.M.); (G.T.); (D.M.); (S.F.); (C.F.); (I.S.); (O.M.)
| | - David Meier
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (P.M.); (G.T.); (D.M.); (S.F.); (C.F.); (I.S.); (O.M.)
| | - Stephane Fournier
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (P.M.); (G.T.); (D.M.); (S.F.); (C.F.); (I.S.); (O.M.)
| | - Clémence Ferlay
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (P.M.); (G.T.); (D.M.); (S.F.); (C.F.); (I.S.); (O.M.)
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (M.K.); (A.N.)
- Adult Intensive Care Unit, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Anna Nowacka
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (M.K.); (A.N.)
| | - Valentina Rancati
- Division of Anesthesiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Christophe Abellan
- Division of Internal Medicine, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Ioannis Skalidis
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (P.M.); (G.T.); (D.M.); (S.F.); (C.F.); (I.S.); (O.M.)
| | - Olivier Muller
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (P.M.); (G.T.); (D.M.); (S.F.); (C.F.); (I.S.); (O.M.)
| | - Henri Lu
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (P.M.); (G.T.); (D.M.); (S.F.); (C.F.); (I.S.); (O.M.)
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Yeom R, Gorgone M, Malinovic M, Panzica P, Maslow A, Augoustides JG, Marchant BE, Fernando RJ, Nampi RG, Pospishil L, Neuburger PJ. Surgical Aortic Valve Replacement in a Patient with Very Severe Chronic Obstructive Pulmonary Disease. J Cardiothorac Vasc Anesth 2023; 37:2335-2349. [PMID: 37657996 DOI: 10.1053/j.jvca.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Richard Yeom
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Michelle Gorgone
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Matea Malinovic
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Peter Panzica
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Bryan E Marchant
- Department of Anesthesiology, Cardiothoracic and Critical Care Sections, Wake Forest University School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC.
| | - Robert G Nampi
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Liliya Pospishil
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
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Ueyama H, Babaliaros VC, Lederman RJ, Greenbaum AB. The 7 Pillars for Transcaval Transcatheter Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:207-211. [PMID: 37294000 PMCID: PMC10330536 DOI: 10.1177/15569845231173926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Hiroki Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Vasilis C. Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Adam B. Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
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