1
|
Conzelmann L, Grotherr P, Dapeng L, Würth A, Widder J, Jacobshagen C, Mehlhorn U. Valve-Related Complications in TAVI Leading to Emergent Cardiac Surgery. Thorac Cardiovasc Surg 2023; 71:107-117. [PMID: 36446625 DOI: 10.1055/s-0042-1758073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is now a standard procedure for the treatment of symptomatic aortic valve stenosis in many patients. In Germany, according to the annual reports from the German Institute for Quality Assurance and Transparency in Healthcare (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen), the rate of serious intraprocedural complications, such as valve malpositioning or embolization, coronary obstruction, aortic dissection, annular rupture, pericardial tamponade, or severe aortic regurgitation requiring emergency cardiac surgery has decreased markedly in recent years from more than 5.5% in 2012 to 2.0% in 2019. However, with increased use, the total number of adverse events remains about 500 per year, about 100 of which require conversion to sternotomy. These, sometimes, fatal events can occur at any time and are still challenging. Therefore, the interdisciplinary TAVI heart team should be prepared and aware of possible rescue strategies.
Collapse
Affiliation(s)
- Lars Conzelmann
- Department of Cardiac Surgery, HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| | - Philipp Grotherr
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Lu Dapeng
- Department of Cardiology, Intensive Care Medicine and Angiology, Vincentius-Diakonissen Hospital Karlsruhe, Karlsruhe, Germany
| | - Alexander Würth
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Julian Widder
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Claudius Jacobshagen
- Department of Cardiology, Intensive Care Medicine and Angiology, Vincentius-Diakonissen Hospital Karlsruhe, Karlsruhe, Germany
| | - Uwe Mehlhorn
- Department of Cardiac Surgery, HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| |
Collapse
|
2
|
Lin N, Nores MA, James TM, Rothenberg M, Stamou SC. Alternative Access Transcatheter Aortic Valve Replacement in Nonagenarians versus Younger Patients. Thorac Cardiovasc Surg 2020; 69:437-444. [PMID: 32252113 DOI: 10.1055/s-0040-1708478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Numerous studies have documented the safety of alternatives access (AA) transcatheter aortic valve replacement (TAVR) for patients who are not candidates for transfemoral or surgical approach. There is a scarcity of studies relating use of AA TAVR in nonagenarian patients, a high-risk, frail group. Our study sought to investigate the clinical outcomes of nonagenarians who underwent AA TAVR for aortic stenosis, with comparison of nonagenarians age ≥90 years with patients age <90 years. METHODS A cohort study of 171 consecutive patients undergoing AA TAVR (transapical [TA, n = 101, 59%], transaxillary [TAX, n = 56, 33%], transaortic [TAO, n = 11, 6%], and transcarotid [TC, n = 3, 2%]) from 2012 to 2019 was analyzed. Baseline, operative, and postoperative characteristics, as well as actuarial survival outcomes, were compared. RESULTS AA TAVR patients had decreased aortic valve gradients with no difference detected in nonagenarians and younger patients. Operative mortality was 8% (n = 14; nine TA, three TAO, and two TAX). Compared to younger patients, significantly more nonagenarians were recorded to have new onset atrial fibrillation (7 vs. 5%, p < 0.01*). No significant difference in mortality or postoperative complications, such as stroke, pacemaker requirements, was detected. Actuarial survival at 1 and 5 years was 86 versus 87% (nonagenarians vs younger patients) and 36 versus 22%, respectively, with log-rank = 0.97. CONCLUSION AA TAVR in nonagenarian patients who are not candidates for transfemoral approach can be efficaciously performed with comparable clinical outcomes to younger patients, age <90 years. Furthermore, some access sites should be avoided when possible; notably TA was associated with increased mortality, stroke, and new onset atrial fibrillation.
Collapse
Affiliation(s)
- Nicole Lin
- Department of Graduate Education, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Marcos A Nores
- Department of Cardiothoracic Surgery, John Fitzgerald Kennedy Medical Center, Atlantis, Florida, United States
| | - Taylor M James
- Department of Graduate Education, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Mark Rothenberg
- Department of Cardiothoracic Surgery, John Fitzgerald Kennedy Medical Center, Atlantis, Florida, United States
| | - Sotiris C Stamou
- Department of Cardiothoracic Surgery, John Fitzgerald Kennedy Medical Center, Atlantis, Florida, United States
| |
Collapse
|
3
|
Heitkemper M, Hatoum H, Azimian A, Yeats B, Dollery J, Whitson B, Rushing G, Crestanello J, Lilly SM, Dasi LP. Modeling risk of coronary obstruction during transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2020; 159:829-838.e3. [PMID: 31230808 PMCID: PMC6859205 DOI: 10.1016/j.jtcvs.2019.04.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/06/2019] [Accepted: 04/16/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In this study we aimed to evaluate risk of coronary obstruction during transcatheter aortic valve replacement and develop improved criteria based on computational modeling. METHODS Patient specific 3-dimensional models were constructed and validated for 28 patients out of 600 patients who were flagged as high risk for coronary obstruction (defined as meeting coronary ostium height < 14 mm and/or sinus of Valsalva diameter [SOVd] < 30 mm). The models consisted finite element analysis to predict the post- transcatheter aortic valve replacement native cusp apposition relative to the coronary ostium and were validated in vitro. The distance from cusp to coronary ostium (DLC) was derived from the 3-dimensional models and indexed with the coronary artery diameter to yield a fractional obstruction measure (DLC/d). RESULTS Twenty-two out of 28 high-risk patients successfully underwent transcatheter aortic valve replacement without coronary obstruction and 6 did not. DLC/d between the 2 groups was significantly different (P < .00078), whereas neither coronary ostium height nor SOVd were significantly different (P > .32). A cutoff of DLC/d < 0.7 was predictive with 100% sensitivity and 95.7% specificity. The optimal sensitivity and specificity of coronary ostium height and SOVd in this high-risk group was only 60% and 40%, respectively, for cutoff coronary ostium height of 10 mm and SOVd of 30.5 mm. CONCLUSIONS Three-dimensional modeling has the potential to enable more patients to be safely treated with transcatheter aortic valve replacement who have a low-lying coronary ostium or small SOVd. DLC/d is more predictive of obstruction than coronary ostium height and SOVd.
Collapse
Affiliation(s)
- Megan Heitkemper
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Amirsepehr Azimian
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Breandan Yeats
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | | | - Bryan Whitson
- Department of Surgery The Ohio State University, Columbus, Ohio
| | - Greg Rushing
- Department of Surgery The Ohio State University, Columbus, Ohio
| | - Juan Crestanello
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio; Department of Surgery The Ohio State University, Columbus, Ohio
| | - Scott M Lilly
- Division of Cardiology, The Ohio State University, Columbus, Ohio
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio; Department of Surgery The Ohio State University, Columbus, Ohio.
| |
Collapse
|
4
|
Conzelmann LO, Würth A, Schymik G, Schröfel H, Anusic T, Temme S, Tzamalis P, Gerhardus J, Mukherjee C, Gonska BD, Schmitt C, Mehlhorn U. Feasibility of transcatheter aortic valve implantation in patients with coronary heights ≤7 mm: insights from the transcatheter aortic valve implantation Karlsruhe (TAVIK) registry. Eur J Cardiothorac Surg 2019; 54:752-761. [PMID: 29617804 DOI: 10.1093/ejcts/ezy130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/27/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) in patients with low coronary heights is generally denied but is not impossible. Information about these high-risk procedures is sparse. METHODS Since May 2008, data of more than 3000 patients who had TAVI were prospectively collected in the institutional TAVI Karlsruhe registry. Characteristics, peri- and postoperative outcome of patients with low coronary heights of ≤7 mm were analysed according to the Valve Academic Research Consortium-2. RESULTS Eighty-six patients with an average coronary height of 6.4 ± 1.1 mm (mean age 81.0 ± 5.3 years, logistic EuroSCORE I 19.6 ± 13.3%) were treated. TAVI was performed in 72 transfemoral (83.7%) and 14 transapical (16.3%) cases using 44 CoreValve/Evolut R (51.2%), 21 Sapien XT/S3 (24.4%), 14 ACURATE (16.3%), 5 Lotus (5.8%) and 2 Portico (2.3%) prostheses. Ten procedures were valve-in-valve (VinV) TAVI (VinV, 11.6%). The 72-h, 30-day, 1-year and follow-up (3.0 ± 1.6 years) mortality rates were 2.3%, 8.0%, 10.5% and 26.7%, respectively. Within 30 days, 4 cardiac deaths and 3 non-cardiac deaths occurred (4.7% and 3.5%). Three coronary obstructions (3.5%) occurred-2 during VinV TAVI. One patient was connected to extracorporeal circulation that could not be weaned later due to an unsuccessful percutaneous coronary intervention. Another patient, the only conversion (1.2%), required delayed surgical valve replacement. The third patient died of right heart failure after aortic dissection. The procedural success rate was 95.3%. VinV procedures were associated with increased follow-up deaths (P < 0.001; hazard ratio 7.96). CONCLUSIONS Coronary-related complications in TAVI procedures in patients with coronary heights ≤7 mm occurred less frequently, but once they occurred, they were serious. These TAVI procedures are feasible, with a high procedural success rate, but meticulous preoperative planning should be mandatory. In VinV procedures, the follow-up mortality rate is increased; therefore, we do not recommend these procedures.
Collapse
Affiliation(s)
| | - Alexander Würth
- Medical Clinic III-Department of Cardiology, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Gerhard Schymik
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | | | - Tonic Anusic
- Institute for Medical Biometric, Epidemiology and Informatics, Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stefanie Temme
- HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| | - Panagiotis Tzamalis
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Jan Gerhardus
- HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| | | | - Bernd-Dieter Gonska
- Medical Clinic III-Department of Cardiology, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Claus Schmitt
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Uwe Mehlhorn
- HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| |
Collapse
|
5
|
Damluji AA, Murman M, Byun S, Moscucci M, Resar JR, Hasan RK, Alfonso CE, Carrillo RG, Williams DB, Kwon CC, Cho PW, Dijos M, Peltan J, Heldman AW, Cohen MG, Leroux L. Alternative access for transcatheter aortic valve replacement in older adults: A collaborative study from France and United States. Catheter Cardiovasc Interv 2018; 92:1182-1193. [DOI: 10.1002/ccd.27690] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/20/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Abdulla A. Damluji
- Beverly and Jerome Fine Cardiac Valve Center, Sinai Hospital of Baltimore; LifeBridge Health Cardiovascular Institute; Baltimore Maryland
- Division of Cardiology; Johns Hopkins University; Baltimore Maryland
| | - Magdalena Murman
- Multidisciplinary Structural Heart Disease Program, the Elaine and Sydney Sussman Cardiac Catheterization Laboratory; University of Miami-Miller School of Medicine; Miami Florida
| | - Seunghwan Byun
- Beverly and Jerome Fine Cardiac Valve Center, Sinai Hospital of Baltimore; LifeBridge Health Cardiovascular Institute; Baltimore Maryland
| | - Mauro Moscucci
- Beverly and Jerome Fine Cardiac Valve Center, Sinai Hospital of Baltimore; LifeBridge Health Cardiovascular Institute; Baltimore Maryland
| | - Jon R Resar
- Division of Cardiology; Johns Hopkins University; Baltimore Maryland
| | - Rani K. Hasan
- Division of Cardiology; Johns Hopkins University; Baltimore Maryland
| | - Carlos E. Alfonso
- Multidisciplinary Structural Heart Disease Program, the Elaine and Sydney Sussman Cardiac Catheterization Laboratory; University of Miami-Miller School of Medicine; Miami Florida
| | - Roger G. Carrillo
- Multidisciplinary Structural Heart Disease Program, the Elaine and Sydney Sussman Cardiac Catheterization Laboratory; University of Miami-Miller School of Medicine; Miami Florida
| | - Donald B. Williams
- Multidisciplinary Structural Heart Disease Program, the Elaine and Sydney Sussman Cardiac Catheterization Laboratory; University of Miami-Miller School of Medicine; Miami Florida
| | - Christopher C. Kwon
- Beverly and Jerome Fine Cardiac Valve Center, Sinai Hospital of Baltimore; LifeBridge Health Cardiovascular Institute; Baltimore Maryland
- Division of Cardiac Surgery, Sinai Hospital of Baltimore; LifeBridge Health Cardiovascular Institute; Baltimore Maryland
| | - Peter W. Cho
- Beverly and Jerome Fine Cardiac Valve Center, Sinai Hospital of Baltimore; LifeBridge Health Cardiovascular Institute; Baltimore Maryland
- Division of Cardiac Surgery, Sinai Hospital of Baltimore; LifeBridge Health Cardiovascular Institute; Baltimore Maryland
| | | | | | - Alan W. Heldman
- Multidisciplinary Structural Heart Disease Program, the Elaine and Sydney Sussman Cardiac Catheterization Laboratory; University of Miami-Miller School of Medicine; Miami Florida
| | - Mauricio G. Cohen
- Multidisciplinary Structural Heart Disease Program, the Elaine and Sydney Sussman Cardiac Catheterization Laboratory; University of Miami-Miller School of Medicine; Miami Florida
| | - Lionel Leroux
- Department of Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque; Université Victor Segalen Bordeaux II; Bordeaux France
| |
Collapse
|
6
|
Vurgun VK, Altin AT, Kilickap M, Candemir B, Akyurek O. Percutaneous transapical approach and transcatheter closure for ventricular tachycardia ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:334-337. [PMID: 29023787 DOI: 10.1111/pace.13213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
In patients with mechanical aortic and mitral valve prosthesis, left ventricular endocardial ablation via retrograde transaortic or antegrade transmitral approach carry high risk of catheter entrapment and death. In such cases, ablation can be performed via ventricular transseptal or transapical approach. Transapical approach, with the ease of catheter maneuverability and better endocardial contact, may be performed surgically or percutaneously. In this case report, we describe a patient with both aortic and mitral mechanical prosthesis who underwent ventricular tachycardia ablation via percutaneous transapical endocardial approach with the use of closure device.
Collapse
Affiliation(s)
| | - Ali Timucin Altin
- Cardiology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Kilickap
- Cardiology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Basar Candemir
- Cardiology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Omer Akyurek
- Cardiology Department, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
7
|
Kallinikou Z, Berger A, Ruchat P, Khatchatourov G, Fleisch I, Korkodelovic B, Henchoz E, Marti RA, Cook S, Togni M, Goy JJ. Transcutaneous aortic valve implantation using the carotid artery access: Feasibility and clinical outcomes. Arch Cardiovasc Dis 2017; 110:389-394. [PMID: 28433509 DOI: 10.1016/j.acvd.2016.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/19/2016] [Accepted: 10/13/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transcarotid access is an alternative route for transcutaneous aortic valve implantation (TAVI) in patients with impossible transfemoral access. AIMS We evaluated the safety, effectiveness and early and late clinical outcomes of CoreValve® implantation via the common carotid artery. METHODS Eighteen patients (10 men, 8 women; mean age 84±5 years) at high surgical risk (mean EuroSCORE II 16±13%) with significant peripheral artery disease underwent TAVI via common carotid artery access under general anaesthesia. Mean aortic valve area was 0.64±0.13cm2 (0.36±0.07cm2/m2). RESULTS At a mean follow-up of 605±352 days, two patients (11%) had died in hospital, on days 6 and 20, as a result of sepsis with multiorgan failure (n=1) or pneumonia (n=1). There were no perioperative deaths, myocardial infarctions or strokes. Perioperative prosthesis embolization occurred in one patient (6%), requiring implantation of a second valve. In-hospital complications occurred in four patients (23%): blood transfusion for transient significant bleeding at the access site in one patient (6%); permanent pacemaker implantation in two patients (11%); and pericardial drainage in one patient (6%). The rate of event-free in-hospital stay was 66%. Post-procedural echocardiography showed very good haemodynamic performance, with a mean gradient of 8±3mmHg. Moderate paravalvular leak was present in one patient (6%). Mean intensive care unit stay was 48±31h; mean in-hospital stay was 7±3 days. CONCLUSION TAVI performed by transcarotid access in this small series of severely ill patients was associated with a low incidence of complications, which were associated with the procedure itself rather than the access route.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Stéphane Cook
- Department of Cardiology, University and Hospital of Fribourg, Switzerland; Clinique Cecil, Lausanne, Switzerland
| | - Mario Togni
- Department of Cardiology, University and Hospital of Fribourg, Switzerland; Clinique Cecil, Lausanne, Switzerland
| | - Jean-Jacques Goy
- Department of Cardiology, University and Hospital of Fribourg, Switzerland; Clinique Cecil, Lausanne, Switzerland.
| |
Collapse
|
8
|
Capretti G, Urena M, Himbert D, Ghodbane W, Gardy Verdonk C, Goublaire C, Alkhoder S, Raffoul R, Carrasco J, Laredo M, Nataf P, Vahanian A. Suprasternal brachiocephalic approach as an alternative route for transcatheter aortic valve implantation: a single-centre experience. EUROINTERVENTION 2017; 12:e1849-e1856. [DOI: 10.4244/eij-d-16-00353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
9
|
Voudris KV, Wong SC, Kaple R, Kampaktsis PN, de Biasi AR, Weiss JS, Devereux R, Krieger K, Kim L, Swaminathan RV, Feldman DN, Singh H, Skubas NJ, Minutello RM, Bergman G, Salemi A. Transapical transcatheter aortic valve replacement in patients with or without prior coronary artery bypass graft operation. J Cardiothorac Surg 2016; 11:158. [PMID: 27899140 PMCID: PMC5129212 DOI: 10.1186/s13019-016-0551-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Transapical approach (TA) is an established access alternative to the transfemoral technique in patients undergoing transcatheter aortic valve replacement (TAVR) for treatment of symptomatic aortic valve stenosis. The impact of prior coronary artery bypass grafting (CABG) on clinical outcomes in patients undergoing TA-TAVR is not well defined. Methods A single center retrospective cohort analysis of 126 patients (male 41%, mean age 85.8 ± 6.1 years) who underwent TA balloon expandable TAVR (Edwards SAPIEN, SAPIEN XT or SAPIEN 3) was performed. Patients were classified as having prior CABG (n = 45) or no prior CABG (n = 81). Baseline clinical characteristics, in-hospital, 30-day, 6 months and one-year clinical outcomes were compared. Results Compared to patients without prior CABG, CABG patients were more likely to be male (62.2 vs. 29.6%, p < 0.001) with a higher STS score (11.66 ± 5.47 vs. 8.99 ± 4.19, p = 0.003), history of myocardial infarction (55 vs. 21.1%, p < 0.001), implantable cardioverter defibrillator (17.8 vs. 3.7%, p = 0.017), left main coronary artery disease (42.2 vs. 4.9%, p < 0.001), and proximal left anterior descending coronary artery stenosis (57.8 vs. 16%, p < 0.001). They also presented with a lower left ventricular ejection fraction (%) (42.3 ± 15.3 vs. 54.3 ± 11.6, p < 0.01) and a larger effective valve orifice area (0.75 ± 0.20 cm2 vs. 0.67 ± 0.14 cm2, p = 0.025). There were no intra-procedural deaths, no differences in stroke (0 vs. 1.2%, p = 1.0), procedure time in hours (3.50 ± 0.80 vs. 3.26 ± 0.86, p = 0.127), re-intubation rate (8.9 vs. 8.6% p = 1.0), and renal function (highest creatinine value 1.73 ± 0.71 mg/ml vs.1.88 ± 1.15 mg/ml, p = 0.43). All-cause mortality at 6 months was similar in both groups (11.4, vs. 17.3% p = 0.44), and one-year survival was 81.8 and 77.8% respectively (p = 0.51). On multivariate analysis, the only factor significantly associated with one-year mortality was prior history of stroke (HR, 2.76; 95% CI, 1.06-7.17, p = 0.037). Conclusion Despite the higher baseline clinical risk profile, patients with history of prior CABG undergoing TA-TAVR had comparable in-hospital, 6 months and one-year clinical outcomes to those without prior CABG.
Collapse
Affiliation(s)
- Konstantinos V Voudris
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - S Chiu Wong
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Ryan Kaple
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Polydoros N Kampaktsis
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Andreas R de Biasi
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Jonathan S Weiss
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Richard Devereux
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Karl Krieger
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Luke Kim
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Rajesh V Swaminathan
- Department of Cardiology, Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC, USA
| | - Dmitriy N Feldman
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Harsimran Singh
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Nikolaos J Skubas
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Robert M Minutello
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Geoffrey Bergman
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA
| | - Arash Salemi
- William Acquavella Heart Valve Center, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA. .,Department of Cardiothoracic Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 525 East 68th St., New York, NY, USA.
| |
Collapse
|
10
|
A Decade of Transapical Aortic Valve Implantation. Ann Thorac Surg 2016; 102:759-765. [DOI: 10.1016/j.athoracsur.2016.02.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 11/20/2022]
|
11
|
Allahwala UK, Hansen PS, Danson EJ, Straiton N, Sinhal A, Walters DL, Bhindi R. Transcatheter aortic valve implantation: current trends and future directions. Future Cardiol 2015; 12:69-85. [PMID: 26696562 DOI: 10.2217/fca.15.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly utilized for the treatment of severe symptomatic aortic stenosis in inoperable and high surgical risk patients. Recent advances in valve technology include repositionable scaffolds and smaller delivery systems, as well as improvement in periprocedural imaging. These advances have resulted in reduction of vascular complications, rates of paravalvular aortic regurgitation and periprocedural stroke and improved overall outcomes. Increasingly, TAVI is the preferred treatment for high-risk surgical patients with severe aortic stenosis. Consequently, there is growing interest for the use of TAVI in lower surgical risk patients. Furthermore, the role of TAVI has expanded to include valve-in-valve procedures for the treatment of degenerative bioprosthetic valves and bicuspid aortic valves. Questions remain in regard to the optimal management of concurrent coronary artery disease, strategies to minimize valve leaflet restriction and treatment of conduction abnormalities as well as identifying newer indications for its use.
Collapse
Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Edward J Danson
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Nicola Straiton
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Darren L Walters
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| |
Collapse
|
12
|
Hahn RT, Kodali S, Tuzcu EM, Leon MB, Kapadia S, Gopal D, Lerakis S, Lindman BR, Wang Z, Webb J, Thourani VH, Douglas PS. Echocardiographic imaging of procedural complications during balloon-expandable transcatheter aortic valve replacement. JACC Cardiovasc Imaging 2015; 8:288-318. [PMID: 25772835 DOI: 10.1016/j.jcmg.2014.12.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) using a balloon-expandable valve is an accepted alternative to surgical replacement for severe, symptomatic aortic stenosis in high risk or inoperable patients. Intraprocedural transesophageal echocardiography (TEE) offers real-time imaging guidance throughout the procedure and allows for rapid and accurate assessment of complications and procedural results. The value of intraprocedural TEE for TAVR will likely increase in the future as this procedure is performed in lower surgical risk patients, who also have lower risk for general anesthesia, but a greater expectation of optimal results with lower morbidity and mortality. This imaging compendium from the PARTNER (Placement of Aortic Transcatheter Valves) trials is intended to be a comprehensive compilation of intraprocedural complications imaged by intraprocedural TEE and diagnostic tools to anticipate and/or prevent their occurrence.
Collapse
Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
| | - Susheel Kodali
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | | | - Martin B Leon
- Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | | | | | | | - Brian R Lindman
- Washington University School of Medicine, St. Louis, Missouri
| | - Zuyue Wang
- Medstar Health Research Institute, Washington, DC
| | - John Webb
- University of British Columbia and St. Paul's Hospital, Vancouver, Ontario, Canada
| | | | - Pamela S Douglas
- Division of Cardiovascular Medicine, Duke University Medical Center, and Duke Clinical Research Institute, Durham, North Carolina
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Thourani VH, Li C, Devireddy C, Jensen HA, Kilgo P, Leshnower BG, Mavromatis K, Sarin EL, Nguyen TC, Kanitkar M, Guyton RA, Block PC, Maas AL, Simone A, Keegan P, Merlino J, Stewart JP, Lerakis S, Babaliaros V. High-Risk Patients With Inoperative Aortic Stenosis: Use of Transapical, Transaortic, and Transcarotid Techniques. Ann Thorac Surg 2015; 99:817-23; discussion 823-5. [DOI: 10.1016/j.athoracsur.2014.10.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 09/24/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
|
15
|
Panchal HB, Ladia V, Amin P, Patel P, Veeranki SP, Albalbissi K, Paul T. A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events in patients undergoing transfemoral versus transapical transcatheter aortic valve implantation using edwards valve for severe aortic stenosis. Am J Cardiol 2014; 114:1882-90. [PMID: 25438917 DOI: 10.1016/j.amjcard.2014.09.029] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 09/21/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
Abstract
The purpose of this meta-analysis was to compare 1 year mortality and major adverse cardiovascular and cerebrovascular events between transfemoral (TF) transcatheter aortic valve implantation (TAVI) and transapical (TA) TAVI performed using Edwards valves. PubMed, Embase, and the Cochrane Center Register of Controlled Trials were searched for studies published from January 2000 through March 2014. Seventeen studies met the inclusion criteria and were included in the analysis. This meta-analysis included total of 2,978 patients with severe aortic stenosis not eligible for traditional surgical procedures who underwent TF TAVI (n = 1,465) or TA TAVI (n = 1,513). End points were in-hospital, 30-day, and 1-year all-cause mortality, stroke, myocardial infarction, major bleeding, and major vascular complications. Odds ratios (ORs) with 95% confidence interval (CIs) were computed, and p values <0.05 were considered to indicate statistical significance. The studies were homogenous for all outcomes except 1-year mortality. There was no significant difference between the TF and TA TAVI groups for 1-year mortality (OR 0.64, 95% CI 0.34 to 1.2, p = 0.16), incidence of stroke (OR 1.14, 95% CI 0.76 to 1.71, p = 0.52), incidence of myocardial infarction (OR 0.62, 95% CI 0.23 to 1.7, p = 0.35), and incidence of bleeding events (OR 0.76, 95% CI 0.51 to 1.14, p = 0.19). Thirty-day all-cause mortality was significantly less with TF TAVI compared with TA TAVI (OR 0.59, 95% CI 0.45 to 0.76, p <0.0001). Major vascular events were significantly higher in the TF TAVI group compared with the TA TAVI group (OR 4.33, 95% CI 3.14 to 5.97, p <0.00001). In conclusion, the results of this meta-analysis of 2,978 patients revealed that TA TAVI had similar 1-year major adverse cardiovascular and cerebrovascular events, fewer major vascular complications, but higher 30-day mortality compared with TF TAVI. In patients with contraindications to TF TAVI, TA TAVI is a reasonable option, although further randomized trials are warranted for evaluating long-term clinical outcomes between TF and TA TAVI.
Collapse
|
16
|
Reents T, Stilz S, Herold U, Deisenhofer I. Transapical access for catheter ablation of left ventricular tachycardia in a patient with mechanical aortic and mitral valve prosthesis. Clin Res Cardiol 2014; 103:1025-7. [DOI: 10.1007/s00392-014-0746-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 07/18/2014] [Indexed: 11/28/2022]
|
17
|
Early outcomes of transcatheter aortic valve replacement in patients with severe aortic stenosis: single center experience. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:84-90. [PMID: 25061453 PMCID: PMC4108731 DOI: 10.5114/pwki.2014.43511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 01/07/2014] [Accepted: 01/15/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Transcatheter aortic valve implantation is a promising alternative to high risk surgical aortic valve replacement. The procedure is mainly indicated in patients with severe symptomatic aortic stenosis who cannot undergo surgery or who are at very high surgical risk. AIM Description early results of our single-center experience with balloon expandable aortic valve implantation. MATERIAL AND METHODS Between July 2011 and August 2012, we screened in total 75 consecutive patients with severe aortic stenosis and high risk for surgery. Twenty-one of them were found ineligible for transcatheter aortic valve implantation (TAVI) because of various reasons, and finally we treated a total of 54 patients with symptomatic severe aortic stenosis (AS) who could not be treated by open heart surgery (inoperable) because of high-risk criteria. The average age of the patients was 77.4 ±7.1; 27.8% were male and 72.2% were female. The number of patients in NYHA class II was 7 while the number of patients in class III and class IV was 47. RESULTS The average mortality score of patients according to the STS scoring system was 8.5%. Pre-implantation mean and maximal aortic valve gradients were measured as 53.2 ±14.1 mm Hg and 85.5 ±18.9 mm Hg, respectively. Post-implantation mean and maximal aortic valve gradients were 9.0 ±3.0 and 18.2 ±5.6, respectively (p < 0.0001). The left ventricular ejection fraction was calculated as 54.7 ±14.4% before the operation and 58.0 ±11.1% after the operation (p < 0.0001). The duration of discharge after the operation was 5.29 days, and a statistically significant correlation between the duration of discharge after the operation and STS was found (r = 0385, p = 0.004). CONCLUSIONS We consider that with decreasing cost and increasing treatment experience, TAVI will be used more frequently in broader indications. Our experience with TAVI using the Edwards-Sapien XT (Edwards Lifesciences, Irvine, CA) devices suggests that this is an effective and relatively safe procedure for the treatment of severe aortic stenosis in suitable patients.
Collapse
|
18
|
Papadopoulos N, Schiller N, Fichtlscherer S, Lehmann R, Weber CF, Moritz A, Doss M, Zierer A. Propensity matched analysis of longterm outcomes following transcatheter based aortic valve implantation versus classic aortic valve replacement in patients with previous cardiac surgery. J Cardiothorac Surg 2014; 9:99. [PMID: 24915763 PMCID: PMC4073508 DOI: 10.1186/1749-8090-9-99] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/27/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of this study was to compare outcome of patients with previous cardiac surgery undergoing transapical aortic valve implantation (Redo-TAVI) to those undergoing classic aortic valve replacement (Redo-AVR) by using propensity analysis. METHODS From January 2005 through May 2012, 52 high-risk patients underwent Redo-TAVI using a pericardial xenograft fixed within a stainless steel, balloon-expandable stent (Edwards SAPIEN™). During the same period of time 167 patients underwent classic Redo-AVR. Logistic regression analysis was used to identify covariates among 11 baseline patient variables including the type of initial surgery. Using the significant regression coefficients, each patient's propensity score was calculated, allowing selectively matched subgroups of 40 patients each. Initial surgery included coronary artery bypass grafting in 30 patients, aortic valve replacement in 7 patients and mitral valve reconstruction in 3 patients in each group. Follow-up was 4 ± 2 years and was 100% complete. RESULTS Postoperative chest tube drainage (163 ± 214 vs. 562 ± 332 ml/24 h, p = 0.02) and incidence of early permanent neurologic deficit (0 vs. 13%, p = 0.04) was lower in patients with Redo-TAVI and there was a trend towards improved 30-day survival (p = 0.06). Also we detected a decreased ventilation time (p = 0.04) and lower transfusion rate of allogenic blood products (p ≤ 0.05) in the Redo-TAVI group. At late follow up differences regarding incidence of major adverse events, including death and permanent neurologic deficits (25% vs. 43%, p = 0.01) statistically supported early postoperative findings. CONCLUSION The encouraging results regarding early and long-term outcomes following TAVI in patients with previous cardiac surgery show, that this evolving approach may be particularly beneficial in this patient cohort.
Collapse
Affiliation(s)
- Nestoras Papadopoulos
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Nina Schiller
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- Division of Cardiology, Johann-Wolfgang-Goethe University Frankfurt/Main, Frankfurt am Main, Germany
| | - Ralf Lehmann
- Division of Cardiology, Johann-Wolfgang-Goethe University Frankfurt/Main, Frankfurt am Main, Germany
| | - Christian F Weber
- Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital Frankfurt/Main, Frankfurt am Main, Germany
| | - Anton Moritz
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Mirko Doss
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Andreas Zierer
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
| |
Collapse
|
19
|
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]
|
20
|
Gökdeniz T, Aykan AÇ, Ağaç MT, Dağdelen S, Çelik Ş. Concomitant Complete Atrioventricular Block and Left Main Coronary Artery Occlusion During Transcatheter Aortic Valve Implantation. Heart Lung Circ 2013; 22:1048-50. [DOI: 10.1016/j.hlc.2013.03.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 03/05/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
|
21
|
Tice JA, Sellke FW, Schaff HV. Transcatheter aortic valve replacement in patients with severe aortic stenosis who are at high risk for surgical complications: summary assessment of the California Technology Assessment Forum. J Thorac Cardiovasc Surg 2013; 148:482-91.e6. [PMID: 24252939 DOI: 10.1016/j.jtcvs.2013.09.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/11/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The California Technology Assessment Forum is dedicated to assessment and public reporting of syntheses of available data on medical technologies. In this assessment, transcatheter aortic valve replacement (TAVR) was evaluated for patients with severe aortic stenosis (AS) who are at high risk for complications. METHODS AND RESULTS In this assessment, 5 criteria were used: Regulatory approval, sufficient scientific evidence to allow conclusions on effectiveness, evidence that the technology improves net health outcomes, evidence that the technology is as beneficial as established methods, and availability of the technology outside investigational settings. In this assessment, all 5 criteria were judged to have been met. The primary benefit of TAVR is the ability to treat AS in patients who would otherwise be ineligible for surgical aortic valve replacement. It may also be useful for patients at high surgical risk by potentially reducing periprocedural complications and avoiding the morbidity and recovery from undergoing heart surgery. Potential harms include the need for conversion to an open procedure, perioperative death, myocardial infarction, stroke, bleeding, valve embolization, aortic regurgitation, heart block that requires a permanent pacemaker, renal failure, pulmonary failure, and major vascular complications such as cardiac perforation or arterial dissection. Potential long-term harms include death, stroke, valve failure or clotting, and endocarditis. As highlighted at the February 2012 California Technology Assessment Forum meeting, the dispersion of this technology to new centers across the United States must proceed with careful thought given to training and proctoring multidisciplinary teams to become new centers of excellence. CONCLUSIONS TAVR is a potentially lifesaving procedure that may improve quality of life for patients at high risk for surgical AVR. However, attention needs to be paid to appropriate patient selection, their preoperative evaluation, surgical techniques, and postoperative care to preserve and improve on the results attained in the Placement of Aortic Transcatheter Valve trial. Specialty societies are collaborating to ensure that this happens in a rational and comprehensive manner.
Collapse
Affiliation(s)
- Jeffrey A Tice
- Division of General Internal Medicine, Department of Medicine University of California San Francisco, San Francisco, Calif
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Brown Medical School and Rhode Island Hospital, Providence, RI.
| | - Hartzell V Schaff
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| |
Collapse
|
22
|
Papadopoulos N, Ilioska P, Fichtlscherer S, Lehmann R, Beiras Fernandez A, Moritz A, Doss M, Zierer A. Transapical aortic valve implantation in patients with previous cardiac surgery. Ann Thorac Surg 2013; 97:37-42. [PMID: 24075497 DOI: 10.1016/j.athoracsur.2013.07.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study compared surgical outcomes of patients with previous cardiac surgery undergoing transapical transcatheter aortic valve implantation (PCS-TA-TAVI) with those of patients undergoing transapical transcatheter aortic valve implantation as an initial procedure (initial TA-TAVI) by using propensity analysis. METHODS From January 2005 through January 2013, 267 consecutive high-risk patients underwent transapical transcatheter aortic valve implantation using a pericardial xenograft fixed within a stainless steel, balloon-expandable stent (Edwards SAPIEN). Of these, 59 patients underwent PCS-TA-TAVI (coronary artery bypass grafting: n = 31; valve surgery: n = 28), and the remaining 208 had an initial TA-TAVI procedure. Logistic regression analysis was used to identify covariates among 10 baseline patient variables. Using the significant regression coefficients, each patient's propensity score was calculated, allowing selectively matched subgroups of 45 patients in the two groups. Operative outcomes were analyzed for differences. Follow-up was 4 ± 2 years and 100% complete. RESULTS There was no significant difference between PCS-TA-TAVI and initial TA-TAVI patients in operative time, postoperative bleeding, 30-day survival (91% versus 93%), and survival at late follow-up (63% versus 68%; p ≥ 0.28). Overall incidence of early stroke was low with 0% for the PCS-TA-TAVI and 4% for initial TA-TAVI group (p = 0.56). Transapical transcatheter aortic valve implantation was successfully performed in all but 1 patient from the initial TA-TAVI group who required conversion to sternotomy. CONCLUSIONS Transapical transcatheter aortic valve implantation has simplified surgical treatment of high-risk patients with previous cardiac surgery and severe aortic valve stenosis and is associated with minimal risk of stroke. Furthermore, current data suggest that the presence of previous cardiac surgery does not impair outcomes after transapical transcatheter aortic valve implantation, making this subset of patients particularly applicable for this evolving approach.
Collapse
Affiliation(s)
- Nestoras Papadopoulos
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
| | - Pamela Ilioska
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- Division of Cardiology, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany
| | - Ralf Lehmann
- Division of Cardiology, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany
| | - Andres Beiras Fernandez
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany
| | - Anton Moritz
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany
| | - Mirko Doss
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany
| | - Andreas Zierer
- Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany
| |
Collapse
|
23
|
Rahnavardi M, Santibanez J, Sian K, Yan TD. A systematic review of transapical aortic valve implantation. Ann Cardiothorac Surg 2013; 1:116-28. [PMID: 23977482 DOI: 10.3978/j.issn.2225-319x.2012.07.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/06/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) through a transapical approach (TAAVI) for severe aortic stenosis becomes the procedure of choice in cases where patients have peripheral artery disease and unfeasible access due to excessive atherosclerotic disease of the iliofemoral vessels and aorta. The present systematic review aimed to assess the safety, success rate, clinical outcomes, hemodynamic outcomes, and survival benefits of TAAVI. METHODS Electronic searches were performed in 6 databases from January 2000 to February 2012. The primary end points included feasibility and safety. Other end points included echocardiographic findings, functional class improvement, and survival. RESULTS After applying the inclusion and exclusion criteria, 48 out of 154 shortlisted potentially relevant articles were selected for assessment. Of these, 26 studies from 24 centers including total number of 2,807 patients were included for appraisal and data extraction. The current evidence on TAAVI for aortic stenosis is limited to observational studies. Successful TAAVI implantation occurred in >90% of patients. On average, the procedure took between 64 to 154 minutes to complete. The incidence of major adverse events included 30-day mortality (4.7-20.8%); cerebrovascular accident (0-16.3%); major tachyarrhythmia (0-48.8%); bradyarrhythmia requiring permanent pacemaker insertion (0-18.7%); cardiac tamponade (0-11%); major bleeding (1-17%); myocardial infarction (0-6%); aortic dissection/rupture (0-5%); moderate to severe paravalvular leak (0.7-24%); cardiopulmonary bypass support (0-15%); conversion to surgery (0-9.5%); and valve-in-valve implantation (0.6-8%). Mean aortic valve area improved from 0.4-0.7 cm(2) before TAAVI to 1.4-2.1 cm(2) after TAAVI. The peak pressure gradient across the aortic valve decreased from >70 mmHg to <20 mmHg after TAAVI. One-year survival ranged from 49.3% to 82% and the 3-year survival was 58% in 2 series. CONCLUSIONS TAAVI appears to be feasible with a reasonable safety and efficacy portfolio. Randomised controlled trials are required to compare transapical vs. transfemoral TAVI when both techniques are equally feasible.
Collapse
Affiliation(s)
- Mohammad Rahnavardi
- The Collaborative Research (CORE) Group, Sydney, Australia; ; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia
| | | | | | | |
Collapse
|
24
|
Thourani VH, Gunter RL, Neravetla S, Block P, Guyton RA, Kilgo P, Lerakis S, Devireddy C, Leshnower B, Mavromatis K, Stewart J, Simone A, Keegan P, Nguyen TC, Merlino J, Babaliaros V. Use of transaortic, transapical, and transcarotid transcatheter aortic valve replacement in inoperable patients. Ann Thorac Surg 2013; 96:1349-1357. [PMID: 23972931 DOI: 10.1016/j.athoracsur.2013.05.068] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 05/19/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an effective treatment in patients with severe aortic stenosis unsuitable for surgical aortic valve replacement (SAVR). This study evaluated the early experience with the posttrial application of TAVR, with specific focus on non-transfemoral (TF) access. METHODS All patients who underwent posttrial TAVR at Emory University from November 2011 to April 2012 were reviewed. During this time, 44 posttrial TAVRs were performed: TF in 18, transapical in 11, transaortic in 12, and transcarotid in 3. RESULTS A total of 40.9% of all patients were candidates for TF implantation. Mean age was 78.2 ± 11.3 years, and 34.1% were women. Mean ejection fraction was 0.463 ± 0.164, and 90.2% had New York Heart Association class III to IV heart failure. Fifty percent were diabetic, 27.3% had moderate to severe chronic obstructive pulmonary disease, and 20.5% had a prior stroke. The mean creatinine was 1.63 ± 1.74 mg/dL, 9.1% required preoperative dialysis, and 61.4% had undergone prior cardiac operations. No patients had postoperative myocardial infarction, stroke, or required new dialysis. Intraoperative vascular complications occurred in 11.4%. No patient had more than mild perivalvular leak by transthoracic echocardiography at discharge. Mean postoperative ventilator time was 17.8 ± 40.1 hours. Intensive care unit length of stay was 58.0 ± 67.0 hours. Postoperative hospital length of stay was 6.1 ± 4.7 days. The 30-day mortality was 6.8% (3 of 44) for all patients, despite a mean The Society of Thoracic Surgeons Predicted Risk of Mortality score of 12.6. CONCLUSIONS Less than half of patients deemed appropriate for posttrial TAVR were candidates for TF implantation. The use of all available access routes leads to excellent outcomes in patients deemed inoperable.
Collapse
Affiliation(s)
- Vinod H Thourani
- Structural Heart and Valve Center, Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Rebecca L Gunter
- Structural Heart and Valve Center, Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Soumya Neravetla
- Structural Heart and Valve Center, Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Peter Block
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert A Guyton
- Structural Heart and Valve Center, Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Patrick Kilgo
- Division of Biostatistics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia
| | - Stamatios Lerakis
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Chandan Devireddy
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Bradley Leshnower
- Structural Heart and Valve Center, Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Kreton Mavromatis
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - James Stewart
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Amy Simone
- Structural Heart and Valve Center, Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Patricia Keegan
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Tom C Nguyen
- Structural Heart and Valve Center, Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John Merlino
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Vasilis Babaliaros
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
25
|
Management of Vascular Access in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2013; 6:767-76. [PMID: 23866177 DOI: 10.1016/j.jcin.2013.05.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/18/2013] [Accepted: 05/09/2013] [Indexed: 11/22/2022]
|
26
|
Okuyama K, Jilaihawi H, Makkar RR. Leaflet length and left main coronary artery occlusion following transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2013; 82:E754-9. [DOI: 10.1002/ccd.25059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/18/2013] [Accepted: 06/01/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Kazuaki Okuyama
- Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Hasan Jilaihawi
- Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Raj R. Makkar
- Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| |
Collapse
|
27
|
Svensson LG, Adams DH, Bonow RO, Kouchoukos NT, Miller DC, O'Gara PT, Shahian DM, Schaff HV, Akins CW, Bavaria JE, Blackstone EH, David TE, Desai ND, Dewey TM, D'Agostino RS, Gleason TG, Harrington KB, Kodali S, Kapadia S, Leon MB, Lima B, Lytle BW, Mack MJ, Reardon M, Reece TB, Reiss GR, Roselli EE, Smith CR, Thourani VH, Tuzcu EM, Webb J, Williams MR. Aortic Valve and Ascending Aorta Guidelines for Management and Quality Measures. Ann Thorac Surg 2013; 95:S1-66. [DOI: 10.1016/j.athoracsur.2013.01.083] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 12/24/2012] [Accepted: 01/15/2013] [Indexed: 12/31/2022]
|
28
|
Lerakis S, Hayek SS, Douglas PS. Paravalvular aortic leak after transcatheter aortic valve replacement: current knowledge. Circulation 2013; 127:397-407. [PMID: 23339094 DOI: 10.1161/circulationaha.112.142000] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Stamatios Lerakis
- Department of Medicine, Division of Cardiology, Emory University Hospital, Atlanta, GA 30322, USA.
| | | | | |
Collapse
|
29
|
Doss M, Buhr EB, Martens S, Moritz A, Zierer A. Transcatheter-Based Aortic Valve Implantations at Midterm: What Happened to Our Initial Patients? Ann Thorac Surg 2012; 94:1400-6. [DOI: 10.1016/j.athoracsur.2012.05.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 05/03/2012] [Accepted: 05/11/2012] [Indexed: 11/30/2022]
|
30
|
Feasibility and accuracy of 3DTEE versus CT for the evaluation of aortic valve annulus to left main ostium distance before transcatheter aortic valve implantation. JACC Cardiovasc Imaging 2012; 5:579-88. [PMID: 22698526 DOI: 10.1016/j.jcmg.2012.02.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/03/2012] [Accepted: 02/14/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aims of this study were to analyze in a large series of patients undergoing transcatheter aortic valve implantation (TAVI): 1) the accuracy of 3-dimensional transesophageal echocardiographic (3DTEE) measurement of left coronary cusp (LCC) length and of the distances from left main coronary ostium (LM) to the aortic annulus (AA) pre-operatively and to the aortic prosthesis post-operatively; and 2) the role of the 3DTEE measurements in predicting the prosthetic deployment and the association between prosthesis position and aortic regurgitation (AR) and/or prosthesis-patient mismatch (PPM). BACKGROUND Coronary ostia occlusion is a possible complication in TAVI; therefore, the careful pre-operative evaluation of AA-LM and LCC length, and the post-operative analysis of the relationship between the prosthesis and LM, may influence the procedural outcomes. Even though multidetector computed tomography (MDCT) is the gold standard pre-operatively, sometimes it cannot be performed and it is rarely repeated post-operatively. METHODS In 122 patients undergoing TAVI, pre-operative AA-LM and LCC measurements obtained by 3DTEE and MDCT were compared. Post-operatively, the feasibility of 3DTEE evaluation of the prosthesis-LM distance was performed. The relationship between 3DTEE overlap of the prosthesis with the anterior mitral leaflet and AR/PPM was assessed. RESULTS Pre-operatively, 3DTEE AA-LM (r = 0.83) and LCC (r = 0.69) significantly correlated with MDCT. Post-operatively, 3DTEE prosthesis-LM distance was 2.1 ± 1.9 mm. The prosthesis reached or exceeded LM in 6 and 10 cases, respectively. Prosthesis overlap with mitral leaflet was 4.7 ± 1.8 mm. Significant correlation between the 3DTEE computed and nominal length of the prosthesis was found (r = 0.61). No correlations were found between prosthesis-mitral leaflet overlap and aortic regurgitation or PPM. CONCLUSIONS AA-LM distance and LCC length may be accurately estimated by 3DTEE, which may represent a valid alternative to MDCT. Pre- and post-3DTEE data concerning the aortic root, such as LM, aortic valve, and prosthetic morphology, give new insights into TAVI and its complications.
Collapse
|
31
|
Beller CJ, Schmack B, Seppelt P, Arif R, Bekeredjian R, Krumsdorf U, Katus HA, Karck M, Kallenbach K. The groin first approach for transcatheter aortic valve implantation: are we pushing the limits for transapical implantation? Clin Res Cardiol 2012; 102:111-7. [DOI: 10.1007/s00392-012-0502-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 07/24/2012] [Indexed: 11/30/2022]
|
32
|
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]
|
33
|
Sündermann SH, Scherman J, Falk V. Minimally invasive and transcatheter techniques in high-risk cardiac surgery patients. Interv Cardiol 2012. [DOI: 10.2217/ica.12.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
34
|
Modine T, Sudre A, Collet F, Delhaye C, Lemesles G, Fayad G, Koussa M. Transcutaneous aortic valve implantation using the axillary/subclavian access with patent left internal thoracic artery to left anterior descending artery: feasibility and early clinical outcomes. J Thorac Cardiovasc Surg 2012; 144:1416-20. [PMID: 22329982 DOI: 10.1016/j.jtcvs.2012.01.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 11/20/2011] [Accepted: 01/06/2012] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Both retrograde femoral and subclavian artery catheterization techniques have been described as the most common methods for the implantation of the Medtronic CoreValve percutaneous aortic valve (Medtronic Inc, Minneapolis, Minn). The subclavian artery has been shown to be a safe and effective alternative access route in patients with unfavorable femoral access. Of the patients who are identified as candidates for subclavian artery access, a subset possess a patent left internal thoracic artery to left anterior descending artery. This patent left internal thoracic artery presents an additional anatomic and clinical variable that must be taken into consideration to ensure procedural safety and efficacy. We describe the Medtronic CoreValve percutaneous aortic valve implantation using the subclavian arterial approach in patients with a patent left internal thoracic artery and report our study's findings. METHODS The CoreValve percutaneous aortic valve is a self-expandable nitinol-based frame with a porcine pericardial valve. The subclavian access was created by a small infraclavicular surgical incision to expose the artery. Rapid ventricular pacing was used to reduce cardiac output to perform the balloon aortic valvuloplasty via a 12F sheath inserted into the subclavian artery. An 18F sheath was then inserted into the artery down into the ascending aorta and used for introduction of the delivery catheter and implantation of the percutaneous aortic valve. RESULTS With the use of this method, 19 patients (76 ± 13 years) whose surgical risk was deemed excessive because of severe comorbidity and in whom transfemoral catheterization was considered unfeasible or at risk of severe complications have received implants. Subclavian artery or left internal thoracic artery injury did not occur in any patient. Two deaths occurred. One patient died of right coronary artery occlusion during the procedure, and one patient died 48 hours after the procedure as the result of a tamponade after the temporary pacemaker wire ablation. CONCLUSIONS This initial experience suggests that subclavian transarterial aortic valve implantation in patients with a patent left internal thoracic artery to left anterior descending artery is feasible and safe with satisfactory short-term outcomes.
Collapse
|
35
|
Beyond the short-term: Clinical outcome and valve performance 2 years after transcatheter aortic valve implantation in 227 patients. J Thorac Cardiovasc Surg 2012; 143:310-7. [DOI: 10.1016/j.jtcvs.2011.10.060] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 08/03/2011] [Accepted: 10/21/2011] [Indexed: 11/18/2022]
|
36
|
Seipelt RG, Hanekop GG, Schoendube FA, Schillinger W. Heart team approach for transcatheter aortic valve implantation procedures complicated by coronary artery occlusion. Interact Cardiovasc Thorac Surg 2012; 14:431-3. [PMID: 22235004 DOI: 10.1093/icvts/ivr136] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We report on three out of 270 consecutive patients (1.1%) suffering from coronary artery obstruction or occlusion at the end of transcatheter aortic valve implantation (TAVI). The partial or total obstruction of the coronary artery seen in the post-implantation aortography was accompanied by haemodynamic instability and electrocardiographic changes typical for myocardial ischaemia. Immediate percutaneous coronary intervention with stent implantation was successful in two cases, while in the third case it was not possible to cross the occluded right coronary artery. Emergency coronary artery bypass grafting was performed resulting in uneventful myocardial recovery. All patients were discharged home. These cases highlight the awareness of this rare, life-threatening complication of TAVI, which is in need of a dedicated heart team involved not only in decision-making, but also in the procedure itself.
Collapse
Affiliation(s)
- Ralf G Seipelt
- Department of Thoracic and Cardiovascular Surgery, Georg-August University, Göttingen, Germany.
| | | | | | | |
Collapse
|
37
|
Bijuklic K, Tuebler T, Reichenspurner H, Treede H, Wandler A, Harreld JH, Low RI, Schofer J. Midterm stability and hemodynamic performance of a transfemorally implantable nonmetallic, retrievable, and repositionable aortic valve in patients with severe aortic stenosis. Up to 2-year follow-up of the direct-flow medical valve: a pilot study. Circ Cardiovasc Interv 2011; 4:595-601. [PMID: 22128202 DOI: 10.1161/circinterventions.111.964072] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Misplacement during percutaneous aortic valve implantation can be associated with severe complications. The direct flow medical (DFM) valve is repositionable and retrievable; however, the nonmetallic inflatable and conformable design of the valve results in less radial force, which may have an impact on stability and valve function over time. We, therefore, analyzed the midterm stability of the position, shape, and hemodynamic performance of the DFM percutaneous aortic valve. METHODS AND RESULTS Sixteen symptomatic high-risk for surgery patients with aortic stenosis and a logistic EuroSCORE >20 underwent implantation and were the subject of this analysis. Clinical, echocardiographic, and dual-source multislice computed tomography data were obtained during 2-year follow-up. The 1- and 2-year survival rates were 81% and 69%, respectively. The dual-source multislice computed tomography follow-up indicated no changes in position, diameter, and orifice area of the DFM valve over time. Echocardiography revealed a significant decrease of the mean gradient from baseline (50.1±11.3 mm Hg) to 30 days (19.6±5.7 mm Hg, P<0.001), which remained stable over 2 years. The aortic valve area increased from 0.57±0.15 cm(2) at baseline to 1.47±0.35 cm(2) at 30 days (P<0.001) and did not significantly change during 2-year follow-up. Of the patients, 73% had no aortic regurgitation (AR) and 27% had minimal AR. CONCLUSIONS In this preliminary series, the 2-year follow-up data of patients, in whom the nonmetallic, repositionable, and retrievable DFM valve was successfully implanted, show stability of the position, shape, and hemodynamic performance, with no AR in most patients.
Collapse
Affiliation(s)
- Klaudija Bijuklic
- Medical Care Center Prof Mathey, Prof Schofer, Hamburg University Cardiovascular Center, Hamburg University Heart Center, and Radiologische Allianz, Hamburg, Germany
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Guinot PG, Depoix JP, Tini L, Vahanian A, Desmonts JM, Montravers P, Longrois D. [Transcutaneous aortic valve implantation: Anesthetic and perioperative management]. ACTA ACUST UNITED AC 2011; 30:734-42. [PMID: 21723077 DOI: 10.1016/j.annfar.2011.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 05/12/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe the perioperative management, from the point of view of the anesthesia-intensive care unit specialist, of patients with aortic stenosis who undergo transcatheter aortic valve implantation (femoral or apical TAVI). DATA SOURCE The PubMed database (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) was queried, using the following keywords: aortic stenosis, transcatheter aortic valve implantation TAVI, outcome, complications, anesthesia. DATA SYNTHESIS TAVI is performed in patients suffering from aortic stenosis and presenting with numerous comorbidities, high-predicted perioperative mortality and/or contraindications to conventional cardiac surgery. TAVI is performed either by percutaneous transfemoral or transapical puncture of the left ventricle (LV) apex. These patients are older, have more comorbidities than those undergoing aortic valve replacement surgery and perioperative mortality predicted by risk scores is higher. While transapical TAVI is performed with general anaesthesia, transfemoral TAVI can be performed with either general or locoregional anaesthesia and/or sedation. The choice of the anaesthetic technique for transfemoral TAVI depends on the patient's medical history, the technique chosen for valve implantation, the type of monitoring and the anticipated hemodynamic problems. The incidence of complications following TAVI is high, some are common to surgical aortic valve replacement, and others are specific to this technique. Because of the prevalence of comorbidities, the hemodynamic-specific constraints of this technique and the incidence of complications, anaesthetic and perioperative management (evaluation, anaesthetic technique, monitoring, post-surgery care) requires the same level of expertise as in cardiac surgery anaesthesia. CONCLUSION TAVI expands treatment options for patients with aortic valve stenosis. The anaesthesia team must be involved in the care of these patients with the same level of expertise and care as in heart surgery on critical patients.
Collapse
Affiliation(s)
- P-G Guinot
- Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, université Paris-7, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | | | | | | | | | | | | |
Collapse
|
39
|
Technik der Transkatheter-Aortenklappenimplantation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00398-011-0852-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
40
|
Incidence and treatment of procedural cardiovascular complications associated with trans-arterial and trans-apical interventional aortic valve implantation in 412 consecutive patients. Eur J Cardiothorac Surg 2011; 40:1105-13. [PMID: 21515069 DOI: 10.1016/j.ejcts.2011.03.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Revised: 03/02/2011] [Accepted: 03/07/2011] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Trans-catheter aortic valve implantation (TAVI) technology is rapidly evolving, with 412 procedures having been performed at our institution. Herein, we report a complete, prospective analysis of complications occurring during transvascular and trans-apical implantations with two different prostheses. METHODS Between June 2007 and June 2010, 412 patients (258 female, mean age 80.3±7.2 years, logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) 20.2%±13.0%) underwent TAVI through either a retrograde (n=252 transfemoral, n=28 transaxillary, and n=5 transaortic) or antegrade (n=127 trans-apical) approach at our institution. The trans-apical access was chosen only in cases where transvascular implantation was not possible. As many as 283 CoreValve and 129 Edwards Sapien prostheses were implanted. RESULTS Thirty-day survival was 90.9%. Vascular complications occurred in 42 patients (10.2%). In four patients, lethal aortic root (n=3) or abdominal (n=1) aortic rupture occurred. Pericardial effusion developed in 53 patients (12.8%), which resulted in cardiac tamponade in 12 patients (2.9%). Twenty-three patients (5.6%) with valve malplacement were treated interventionally. In five patients (1.2%), emergency institution of cardiopulmonary bypass was required during the procedure for temporary support; all patients survived. Seventeen patients underwent re-intervention on the catheter valve (4.1%). CONCLUSIONS With growing experience, complications with TAVI may be avoided by proper patient selection and skillful management. Other complications, when they occur, require a specific treatment algorithm to avoid delay in decision making. A considerable number of complications after TAVI require surgical treatment. Therefore, the ideal environment for TAVI procedures is a hybrid operating room, where a multidisciplinary team of surgeons, cardiologists, and anesthesiologists is best fitted to meet the current needs associated with TAVI technology. A reduction in complications was seen after 300 cases. This finding attests to the complexity of the procedure in addition to the experience required to reduce the incidence of complications.
Collapse
|
41
|
Baranowski J, Ahn H, Freter W, Nielsen NE, Nylander E, Janerot-Sjoberg B, Sandborg M, Wallby L. Echo-guided presentation of the aortic valve minimises contrast exposure in transcatheter valve recipients. Catheter Cardiovasc Interv 2011; 77:272-5. [DOI: 10.1002/ccd.22747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
42
|
Modine T, Obadia JF, Choukroun E, Rioufoul G, Sudre A, Laborde JC, Leprince P. Transcutaneous aortic valve implantation using the axillary/subclavian access: Feasibility and early clinical outcomes. J Thorac Cardiovasc Surg 2011; 141:487-91, 491.e1. [DOI: 10.1016/j.jtcvs.2010.01.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 01/04/2010] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
|
43
|
Outcome after valve surgery in octogenarians and efficacy of early mobilization with early cardiac rehabilitation. Gen Thorac Cardiovasc Surg 2010; 58:606-11. [DOI: 10.1007/s11748-010-0665-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 06/14/2010] [Indexed: 10/18/2022]
|
44
|
Geisbüsch S, Bleiziffer S, Mazzitelli D, Ruge H, Bauernschmitt R, Lange R. Incidence and Management of CoreValve Dislocation During Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2010; 3:531-6. [DOI: 10.1161/circinterventions.110.944983] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background—
Transcatheter aortic valve implantation is a highly specialized technique offering a new therapeutic option to patients at high risk for conventional surgery. Complications associated with this catheter procedure differ from complications after surgical aortic valve replacement. This is to report incidence, management, and impact on morbidity and mortality of CoreValve dislocation during catheter valve implantation.
Methods and Results—
Between June 2007 and September 2009, the self-expandable CoreValve prosthesis (Medtronic Inc, Minneapolis, Minn) was implanted in 212 patients through a transarterial (femoral or subclavian) access. Patients with severe aortic stenosis who were at high risk for conventional surgery were included. We observed dislocation of the prosthesis during CoreValve implantation in 21 patients. In 16 cases, the CoreValve could be implanted in the correct annular position after retrieving it and reloading the catheter. In 4 patients, the completely deployed prosthesis had to be placed in the ascending or abdominal aorta before implanting a second one. One patient underwent open surgery. Overall 30-day mortality was 11.0%, 21.5% in the dislocation group and 9.9% in patients without dislocation (
P
=0.024). Coronary ischemia, stroke, and renal failure occurred more frequently in patients with dislocation, whereas pacemaker dependency did not differ significantly between the groups.
Conclusions—
CoreValve dislocation during transcatheter aortic valve implantation occurred in 10% of the cases and significantly increases perioperative risk for severe complications or death. It requires individual specific management and can be managed either interventionally or, rarely, results in open surgery.
Collapse
Affiliation(s)
- Sarah Geisbüsch
- From the Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Sabine Bleiziffer
- From the Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Domenico Mazzitelli
- From the Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Hendrik Ruge
- From the Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Robert Bauernschmitt
- From the Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Rüdiger Lange
- From the Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| |
Collapse
|
45
|
Modine T, Lemesle G, Azzaoui R, Sudre A. Aortic valve implantation with the CoreValve ReValving System via left carotid artery access: First case report. J Thorac Cardiovasc Surg 2010; 140:928-9. [DOI: 10.1016/j.jtcvs.2010.03.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 02/16/2010] [Accepted: 03/01/2010] [Indexed: 11/30/2022]
|
46
|
Guinot PG, Depoix JP, Etchegoyen L, Benbara A, Provenchère S, Dilly MP, Philip I, Enguerand D, Ibrahim H, Vahanian A, Himbert D, Al-Attar N, Nataf P, Desmonts JM, Montravers P, Longrois D. Anesthesia and Perioperative Management of Patients Undergoing Transcatheter Aortic Valve Implantation: Analysis of 90 Consecutive Patients With Focus on Perioperative Complications. J Cardiothorac Vasc Anesth 2010; 24:752-61. [DOI: 10.1053/j.jvca.2009.12.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Indexed: 11/11/2022]
|
47
|
Heinze H, Sier H, Schäfer U, Heringlake M. Percutaneous aortic valve replacement: overview and suggestions for anesthestic management. J Clin Anesth 2010; 22:373-8. [DOI: 10.1016/j.jclinane.2010.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 04/22/2010] [Accepted: 05/16/2010] [Indexed: 10/19/2022]
|
48
|
Transapical Aortic Valve Implantation Without Angiography: Proof of Concept. Ann Thorac Surg 2010; 89:1925-32. [DOI: 10.1016/j.athoracsur.2010.02.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/10/2010] [Accepted: 02/12/2010] [Indexed: 11/23/2022]
|
49
|
Yan TD, Cao C, Martens-Nielsen J, Padang R, Ng M, Vallely MP, Bannon PG. Transcatheter aortic valve implantation for high-risk patients with severe aortic stenosis: A systematic review. J Thorac Cardiovasc Surg 2010; 139:1519-28. [DOI: 10.1016/j.jtcvs.2009.08.037] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 06/28/2009] [Accepted: 08/09/2009] [Indexed: 11/30/2022]
|
50
|
Fassl J, Augoustides JG. Transcatheter Aortic Valve Implantation—Part 1: Development and Status of the Procedure. J Cardiothorac Vasc Anesth 2010; 24:498-505. [DOI: 10.1053/j.jvca.2009.06.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Indexed: 11/11/2022]
|