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Moccetti F, Wolfrum M, Bossard M, Attinger-Toller A, Loretz L, Cuculi F, Toggweiler S. Transfemoral-only transcatheter aortic valve replacement: A single center experience of 400 consecutive patients. Catheter Cardiovasc Interv 2024; 104:134-144. [PMID: 38736247 DOI: 10.1002/ccd.31077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND In transcatheter aortic valve replacement (TAVR), transfemoral (TF) access offers several advantages over alternative access routes. Advances in sheaths and valve delivery technology have catalyzed the feasibility of TF-TAVR, even in challenging anatomies. AIMS Report procedural characteristics and outcomes of a TAVR program aiming for a 100% TF access rate. METHODS Consecutive patients undergoing TAVR were enrolled in a prospective registry. Equipment used to facilitate TF-access in challenging anatomies included low-profile sheaths, dilatators, peripheral balloons, covered and uncovered self-expanding and balloon-expandable stents, and intravascular lithotripsy (IVL). RESULTS A total of 400 patients with a mean age of 81 ± 6 years (42% female) were analyzed. Minimal iliofemoral artery diameter (MLD) of the main access side was <5 mm in 42 (10.5%), extreme tortuosity was present in 65 (16.3%), and severe calcification in 59 (14.8%). TF-access was successful in 399 (99.8%) patients. A transaxillary access was used in one patient. In multivariable analysis, an MLD < 5 mm was the strongest predictor for vascular complications (11.9% vs. 3.9%, OR: 3.86, 95% CI: 1.38-10.8, p = 0.01). Such patients also had more major/life-threatening bleeding (14.2% vs. 3.1%, p < 0.001) and required more planned and unplanned peripheral interventions to enable TF access (35.8% vs. 3.4%, p < 0.001). CONCLUSION Our study shows that utilization of dedicated sheaths, peripheral balloons, stents, and IVL enables TAVR via TF access in >99% of patients. However, rates of vascular and bleeding complications in patients with narrow iliofemoral arteries (MLD < 5 mm) were high.
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Affiliation(s)
- Federico Moccetti
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Bossard
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Lucca Loretz
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
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Munguti C, Ndunda P, Vindhyal MR, Abukar A, Abdel-Jawad M, Fanari Z. Transcarotid versus transthoracic transcatheter aortic valve replacement: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 63:8-13. [PMID: 38320876 DOI: 10.1016/j.carrev.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/27/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Transthoracic approaches may be contraindicated in some patients and may be associated with poorer outcomes. Therefore other alternative access routes are increasingly being performed. We conducted a systematic review of the literature on Transcarotid transcatheter aortic valve replacement (TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access routes. METHODS We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We presented data using risk ratios (95 % confidence intervals) and measured heterogeneity using Higgins' I2. RESULTS Sixteen observational studies on Transcarotid TAVR were included in the analysis; 4 studies compared 180 TC-TAVR patients vs 524 TT-TAVR patients. The mean age and STS score for patients undergoing TC-TAVR were 80 years and 7.6 respectively. For TT-TAVR patients, the mean age and STS score were 79.7 years and 8.7 respectively. TC-TAVR patients had lower 30-day MACE [7.8 % vs 13.7 %; OR 0.54 (95 % CI 0.29-0.99, P = 0.05)] and major or life-threatening bleeding [4.0 % vs 14.2 %; OR 0.25 (95 % CI 0.09-0.67, P = 0.006)]. There was no significant difference in 30-day: mortality [5.0 % vs 8.6 %; OR 0.61 (95 % CI 0.29-1.30, P = 0.20)], stroke or transient ischemic attack [2.8 % vs 4.0 %; OR 0.65 (95 % CI 0.25-1.73, P = 0.39)] and moderate or severe aortic valve regurgitation [5.0 % vs 4.6 %; OR 1.14. (95 % CI 0.52-2.52, P = 0.75)]. There was a trend towards fewer major vascular complications in TC-TAVR [3.0 % vs 7.8 %; OR 0.42 (95 % CI 0.16-1.12, P = 0.08)]. CONCLUSION Compared with transthoracic TAVR, TC-TAVR patients had lower odds of 30-day MACE and life-threatening bleeding and no differences in 30-day mortality, stroke or TIA, aortic valve regurgitation.
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Affiliation(s)
- Cyrus Munguti
- Internal Medicine, University of Kansas School of Medicine - Wichita, KS, United States of America
| | - Paul Ndunda
- Internal Medicine, University of Kansas School of Medicine - Wichita, KS, United States of America
| | - Mohinder R Vindhyal
- Internal Medicine, University of Kansas School of Medicine - Wichita, KS, United States of America
| | - Abdullah Abukar
- Internal Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Mohammed Abdel-Jawad
- Internal Medicine, University of Kansas School of Medicine - Wichita, KS, United States of America; Internal Medicine, Ascension Via Christi St Francis Hospital, Wichita, KS, United States of America
| | - Zaher Fanari
- Internal Medicine/Cardiology, University of California San Francisco, Fresno, CA, United States of America
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Yamani N, Ali SH, Sadiq M, Ahmed AB, Bhojwani KD, Lohana VP, Fatmah S, Khalid S, Shamsi HR, Zehra B, Fatima K, Baloch ZQ. Trans-femoral versus trans-carotid access for transcatheter aortic valve replacement: an updated systematic review and meta-analysis. Future Sci OA 2024; 10:FSO930. [PMID: 38817364 PMCID: PMC11137775 DOI: 10.2144/fsoa-2023-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/27/2023] [Indexed: 06/01/2024] Open
Abstract
Aim: This meta-analysis aims to shed light on any primacy the trans-carotid (TC-TAVR) access may have over the trans-femoral access (TF-TAVR) for those undergoing transcatheter aortic valve replacement (TAVR). Methods: PubMed/MEDLINE and Cochrane Library were searched, from inception to March 2023 retrieving seven adjusted studies with a total of 6609 patients, of which 5048 underwent TF-TAVR while 1561 underwent TC-TAVR. Results: No divergence in risk of mortality, major bleeding or stroke/transient ischemic attack in TC-TAVR when compared with TF-TAVR was found. In TC-TAVR, the risk of vascular complications was low (OR: 0.51, 95% CI: 0.32-0.83, p = 0.003) as compared with TF-TAVR. Conclusion: As of this analysis, the viability of TC-TAVR as first alternative to TF-TAVR is plausible.
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Affiliation(s)
- Naser Yamani
- Division of Cardiology, University of Arizona Phoenix Medical Center, AZ 85721, USA
| | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Mahnoor Sadiq
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Afeera B Ahmed
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Kapil D Bhojwani
- Faculty of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Vivek P Lohana
- Faculty of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Saba Fatmah
- Faculty of Medicine, Karachi Medical & Dental College, Karachi, 74700, Pakistan
| | - Shazra Khalid
- Faculty of Medicine, Sindh Medical College, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
| | - Hammad R Shamsi
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Batool Zehra
- Faculty of Medicine, Karachi Medical & Dental College, Karachi, 74700, Pakistan
| | - Kaneez Fatima
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Zulfiqar Q Baloch
- Division of Cardiology, Sparrow Hospital, Michigan State University, MI 48912, USA
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4
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Munguti C, Ndunda PM, Abukar A, Jawad MA, Vindhyal MR, Fanari Z. Transcarotid versus transfemoral transcatheter aortic valve replacement: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00151-9. [PMID: 38594159 DOI: 10.1016/j.carrev.2024.04.008] [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: 02/09/2024] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND In the 2021 Transcatheter Valve Therapy (TVT) registry, 8.9 % of patients underwent TAVR via access sites other than the femoral artery. Transthoracic approaches may be contraindicated in some patients and may be associated with poorer outcomes. Therefore other alternative access routes are increasingly being performed. We conducted a systematic review of the literature on transcarotid transcatheter aortic valve replacement (TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access routes. METHODS We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We presented data using risk ratios (95 % confidence intervals) and measured heterogeneity using Higgins' I2. RESULTS Sixteen observational studies on transcarotid TAVR were included in the analysis; 4 studies compared TC-TAVR vs TF-TAVR. The mean age and STS score for patients undergoing TC-TAVR were 80 years and 7.6 respectively. For TF-TAVR patients, mean age and STS score were 81.2 years and 6.5 respectively. There was no difference between patients undergoing TC-TAVR and TF-TAVR in the following 30-day outcomes: MACE [8.4 % vs 6.7 %; OR 1.32 (95 % CI 0.71-2.46 p = 0.38) I2 = 0 %], mortality [5.6 % vs 4.0 %; OR 0.42 (95 % CI 0.60-3.37, P = 0.42) I2 = 0 %] and stroke [0.7 % vs 2.3 %; OR 0.49 (95 % CI 0.09-2.56, P = 0.40) I2 = 0 %]. There was no difference in 30-day major vascular complications [0.7 % vs 3 %; OR 0.55 (95 % CI 0.06-5.29, P = 0.61) I2 = 39 %], major bleeding [0.7 % vs 3.8 %; OR 0.39 (95 % CI 0.09-1.67, P = 0.21) I2 = 0 %], and moderate or severe aortic valve regurgitation [8.6 % vs 9.9 %; OR 0.89 (95 % CI 0.48-1.65, P = 0.72) I2 = 0 %]. CONCLUSION There are no significant differences in mortality, stroke MACE and major or life-threatening bleeding or vascular complications when TC-TAVR is compared to TF-TAVR approaches.
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Affiliation(s)
- Cyrus Munguti
- Department of Internal Medicine, University of Kansas School of Medicine, Wichita, KS, USA; Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Paul M Ndunda
- Division of Cardiology, Louisiana State University in Shreveport, Shreveport, LA, USA
| | - Abdullah Abukar
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mohammed Abdel Jawad
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, KS, USA
| | - Mohinder R Vindhyal
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Zaher Fanari
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA, USA; Division of Cardiology, University of California San Francisco, Fresno, CA, USA.
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5
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Allen KB, Watson D, Vora AN, Mahoney P, Chhatriwalla AK, Schwartz JG, Keller A, Sodhi N, Haugan D, Caskey M. Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysis. JTCVS Tech 2023; 21:45-55. [PMID: 37854813 PMCID: PMC10580150 DOI: 10.1016/j.xjtc.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 10/20/2023] Open
Abstract
Transaxillary access has been the most frequently used nonfemoral access route for transcatheter aortic valve replacement (TAVR) with a self-expanding valve. Use of transcarotid TAVR is increasing; however, comparative data on these methods are limited. We compared outcomes following transcarotid or transaxillary TAVR with a self-expanding, supra-annular valve. Methods The Transcatheter Valve Therapy Registry was queried for TAVR procedures using transaxillary and transcarotid access between July 2015 and June 2021. Patients received a self-expanding Evolut R, PRO, or PRO + valve (Medtronic) and had 1-year follow-up. Thirty-day and 1-year outcomes were compared in transcarotid and transaxillary groups after 1:2 propensity score-matching. Multivariable regression models were fitted to identify predictors of key end points. Results The propensity score-matched cohort included 576 patients receiving transcarotid and 1142 receiving transaxillary access. Median procedure time (99 vs 118 minutes; P < .001) and hospital stay (2 vs 3 days; P < .001) were shorter with transcarotid versus transaxillary access. At 30 days, patients with transcarotid access had similar mortality (Kaplan-Meier estimates 3.7% vs 4.3%, P = .57) but significantly lower stroke (3.1% vs 5.9%; P = .017) and mortality or stroke (6.0% vs 8.9%; P = .033) compared with patients receiving transaxillary access. Similar differences were observed at 1 year. Transaxillary access was associated with increased risk of 30-day stroke (hazard ratio, 2.14; 95% confidence interval, 1.27-3.58) by multivariable regression analysis. Conclusions Transcarotid versus transaxillary access for TAVR using a self-expanding valve is associated with procedural benefits and significantly lower stroke and mortality or stroke at 30 days. In patients with unsuitable femoral anatomy, transcarotid access may be the preferred delivery route for self-expanding valves.
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Affiliation(s)
- Keith B. Allen
- Department of Cardiovascular/Thoracic Surgery, St Luke’s Mid America Heart Institute, Kansas City, Mo
| | - Daniel Watson
- Department of Cardiovascular/Thoracic Surgery, Riverside Methodist Hospital, Columbus, Ohio
| | - Amit N. Vora
- Department of Cardiology, University of Pittsburgh Medical Center Pinnacle Heart and Vascular Institute, Wormleysburg, Pa
| | - Paul Mahoney
- Department of Cardiology, Sentara Heart Hospital, Norfolk, Va
| | | | - Jonathan G. Schwartz
- Department of Cardiology, Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
| | - Antoine Keller
- Department of Cardiovascular/Thoracic Surgery, Ochsner Lafayette General Hospital, Lafayette, La
| | | | | | - Michael Caskey
- Department of Cardiovascular/Thoracic Surgery, Abrazo Arizona Heart Hospital, Phoenix, Ariz
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6
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Junquera L, Kalavrouziotis D, Dumont E, Rodés-Cabau J, Mohammadi S. Paradigm shifts in alternative access for transcatheter aortic valve replacement: An update. J Thorac Cardiovasc Surg 2023; 165:1359-1370.e2. [PMID: 34052017 DOI: 10.1016/j.jtcvs.2021.04.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Lucía Junquera
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eric Dumont
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Kaneko T, Hirji SA, Yazdchi F, Sun YP, Nyman C, Shook D, Cohen DJ, Stebbins A, Zeitouni M, Vemulapalli S, Thourani VH, Shah PB, O'Gara P. Association Between Peripheral Versus Central Access for Alternative Access Transcatheter Aortic Valve Replacement and Mortality and Stroke: A Report From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circ Cardiovasc Interv 2022; 15:e011756. [PMID: 36126131 DOI: 10.1161/circinterventions.121.011756] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In some patients, the alternative access route for transcatheter aortic valve replacement (TAVR) is utilized because the conventional transfemoral approach is not felt to be either feasible or optimal. However, accurate prognostication of patient risks is not well established. This study examines the associations between peripheral (transsubclavian/transaxillary, and transcarotid) versus central access (transapical and transaortic) in alternative access TAVR and 30-day and 1-year end points of mortality and stroke for all valve platforms. METHODS Using data from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry with linkage to Medicare claims, patients who underwent alternative access TAVR from June 1, 2015 to June 30, 2018 were identified. Adjusted and unadjusted Cox proportional hazards modeling were performed to determine the association between alternate access TAVR site and 30-day and 1-year end points of mortality and stroke. RESULTS Of 7187 alternative access TAVR patients, 3725 (52%) had peripheral access and 3462 (48%) had central access. All-cause mortality was significantly lower in peripheral access versus central access group at in-hospital and 1 year (2.9% versus 6.3% and 20.3% versus 26.6%, respectively), but stroke rates were higher (5.0% versus 2.8% and 7.3% versus 5.5%, respectively; all P<0.001). These results persisted after 1-year adjustment (death adjusted hazard ratio, 0.72 [95% CI, 0.62-0.85] and stroke adjusted hazard ratio, 2.92 [95% CI, 2.21-3.85]). When broken down by individual subtypes, compared with transaxillary/subclavian access patients, transapical, and transaortic access patients had higher all-cause mortality but less stroke (P<0.05). CONCLUSIONS In this real-world, contemporary, nationally representative benchmarking study of alternate access TAVR sites, peripheral access was associated with favorable mortality and morbidity outcomes compared with central access, at the expense of higher stroke. These findings may allow for accurate prognostication of risk for patient counseling and decision-making for the heart team with regard to alternative access TAVR.
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Affiliation(s)
- Tsuyoshi Kaneko
- Division of Thoracic and Cardiac Surgery (T.K., S.H., F.Y.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sameer A Hirji
- Division of Thoracic and Cardiac Surgery (T.K., S.H., F.Y.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Farhang Yazdchi
- Division of Thoracic and Cardiac Surgery (T.K., S.H., F.Y.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yee-Ping Sun
- Division of Cardiovascular Medicine (Y.P.S., P.S., P.O.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Charles Nyman
- Division of Cardiac Anesthesia (C.N., D.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Douglas Shook
- Division of Cardiac Anesthesia (C.N., D.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY (D.J.C.).,Duke Clinical Research Institute, Durham, NC (D.J.C.)
| | | | | | | | | | - Pinak B Shah
- Division of Cardiovascular Medicine (Y.P.S., P.S., P.O.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Patrick O'Gara
- Division of Cardiovascular Medicine (Y.P.S., P.S., P.O.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Transfemoral versus transcarotid access for transcatheter aortic valve replacement. JTCVS Tech 2022; 15:46-53. [PMID: 36276673 PMCID: PMC9579710 DOI: 10.1016/j.xjtc.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/09/2022] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To compare the outcomes after transcatheter aortic valve replacement (TAVR) through a transfemoral (TF) and transcarotid (TC) access at our institution. Methods From January 2014 to January 2020, 62 TC-TAVR and 449 TF-TAVR were performed using 2 prosthesis devices (Edwards SAPIEN 3, n = 369; Medtronic Evolut R, n = 142). Propensity score matching was used to adjust for imbalance in the baseline characteristics of the study groups. Results Propensity score matching provided 62 matched pairs with comparable operative risk (mean European System for Cardiac Operative Risk Evaluation II, TC-TAVR 7.6% vs TF-TAVR 6.6%, P = .17). Thirty-day mortality (4.8% vs 3.2%, P = 1.00) and 2-year mortality (11.3% vs 12.9%, P = .64) after TC-TAVR were comparable with TF-TAVR. Strokes were numerically more frequent after TC-TAVR compared with TF-TAVR (3.2% vs 0%, P = .23), but the difference did not reach statistical significance. TF-TAVR was associated with a significantly greater risk of permanent pacemaker implantation (29.0% vs 12.9%, P = .04) compared with TC-TAVR. Other complications were not frequent and were similarly distributed between the matched groups. Conclusions TC access for TAVR was associated with satisfactory results compared to the femoral access. TC-TAVR could be considered a valid and safe alternative to TF-TAVR when femoral access is contraindicated.
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9
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Useini D, Schlömicher M, Haldenwang P, Buchwald D, Strauch J. Transapical-transcatheter aortic valve implantation in patients without transvascular options: Modified transapical approach. J Card Surg 2022; 37:1635-1641. [PMID: 35289959 DOI: 10.1111/jocs.16408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Outcomes in patients with iliofemoral and concomitant iliofemoral-remote arteriopathies who cannot undergo transfemoral or other alternative transvascular approaches have not been studied so far. This study aimed to evaluate the early and midterm outcomes after transapical (TA)-transcatheter aortic valve implantation (TAVI) in patients with femoral and femoral-remote arteriopathies who cannot undergo transvascular approaches. METHODS Multimorbid patients with severe aortic stenosis and distinct panarteriopathy underwent TA-TAVI treatment between January 2012 and January 2021 at the authors' institution. Second- and third-generation self- and balloon-expanding valves were used. For patients without arterial access, TA-TAVI was modified to the artery-no-touch technique. RESULTS Seventy-two consecutive elderly patients (78.2 ± 6.9 years; 73% male) were included in the study. The Society of Thoracic Surgery-Predicted Risk of Mortality score was 7 ± 5%. No procedural deaths or conversion to conventional surgery was registered. The 30-day and midterm mortality rates were 5% and 28%, respectively. The median time of freedom from a composite of death and cardiocerebral adverse events was 34.3 months (95% confidence interval: 17.6-51.1). The rate of moderate/severe paravalvular leakage was 0%. The pacemaker rate was 11%. CONCLUSIONS TA-TAVI is a safe method with low-rate procedural complications and shows good early and midterm outcomes in patients with extensive panarteriopathy for whom transfemoral and other alternative transvascular approaches are contraindicated or at high interventional risk. The modified artery-no-touch TA-TAVI method is safe and feasible for selected patients with no other possible arterial approach.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Dirk Buchwald
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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10
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Lodo V, Scrocca I, Zingarelli EM, Pietropaolo C, Fadde M, Ferri M, Gaggiano A, Buono G, Musumeci G, Centofanti P. Another step in transcatheter aortic valve implantation: A challenging transcatheter aortic valve implantation procedure in patient with severe peripheral arterial disease. Clin Case Rep 2022; 10:e05407. [PMID: 35145692 PMCID: PMC8818288 DOI: 10.1002/ccr3.5407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Abstract
Approximately 25% of patients undergoing transcatheter aortic valve implantation presents significant peripheral arterial disease. The purpose of this case report was to present a feasible approach for transcatheter heart valve in a patient with peripheral arterial disease where the presence of a subclavian stent jutting in the aortic arch made the delivery system passage a challenging procedure.
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Affiliation(s)
- Vittoria Lodo
- Division of Cardiac Surgery Center for Valvular Heart Disease Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Innocenzo Scrocca
- Division of Cardiology Center for Valvular Heart Disease Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Edoardo M. Zingarelli
- Division of Cardiac Surgery Center for Valvular Heart Disease Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Claudio Pietropaolo
- Division of Cardiovascular Anesthesia and Intensive Care Center for Valvular Heart Disease Azienda Ospedaliera Ordine Mauriziano Turin Italy
| | - Marco Fadde
- Division of Cardiovascular Anesthesia and Intensive Care Center for Valvular Heart Disease Azienda Ospedaliera Ordine Mauriziano Turin Italy
| | - Michelangelo Ferri
- Division of Vascular and Endovascular Surgery Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Andrea Gaggiano
- Division of Vascular and Endovascular Surgery Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Gabriella Buono
- Division of Cardiovascular Anesthesia and Intensive Care Center for Valvular Heart Disease Azienda Ospedaliera Ordine Mauriziano Turin Italy
| | - Giuseppe Musumeci
- Division of Cardiology Center for Valvular Heart Disease Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
| | - Paolo Centofanti
- Division of Cardiac Surgery Center for Valvular Heart Disease Azienda Ospedaliera Ordine Mauriziano di Torino Turin Italy
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11
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De Boulle M, Debing E, Belsack D, Vandeloo B. Carotid access for percutaneous coronary intervention. Clin Case Rep 2021; 9:e04739. [PMID: 34484772 PMCID: PMC8405523 DOI: 10.1002/ccr3.4739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/05/2021] [Indexed: 11/11/2022] Open
Abstract
Transcarotid percutaneous coronary intervention is feasible and safe and can be considered as an ultimate alternative in cases where conventional peripheral vascular access is unavailable.
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Affiliation(s)
- Matthias De Boulle
- Centrum voor Hart‐ en VaatziektenVrije Universiteit Brussel (VUB)Universitair Ziekenhuis Brussel (UZ Brussel)BrusselsBelgium
| | - Erik Debing
- Centrum voor Hart‐ en VaatziektenVrije Universiteit Brussel (VUB)Universitair Ziekenhuis Brussel (UZ Brussel)BrusselsBelgium
| | - Dries Belsack
- Department of RadiologyVrije Universiteit Brussel (VUB)Universitair Ziekenhuis Brussel (UZ Brussel)BrusselsBelgium
| | - Bert Vandeloo
- Centrum voor Hart‐ en VaatziektenVrije Universiteit Brussel (VUB)Universitair Ziekenhuis Brussel (UZ Brussel)BrusselsBelgium
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12
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Useini D, Beluli B, Christ H, Schlömicher M, Patsalis P, Haldenwang P, Strauch J. Transcatheter Aortic Valve Implantation in Patients Who Cannot Undergo Transfemoral Access. Thorac Cardiovasc Surg 2021; 70:189-198. [PMID: 33851408 DOI: 10.1055/s-0041-1727131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Though transfemoral (TF) access has emerged as a gold standard access for patients with aortic stenosis who undergo transcatheter aortic valve implantation (TAVI), there has been no study that has characterized patients who cannot undergo TF access in detail. We aim to evaluate the contraindications for TF access, their incidence, classify them, and provide the outcomes of patients who failed to be TF candidates. METHODS From 925 patients who underwent TAVI between February 2014 and May 2020 at our heart center, 130 patients failed to be TF candidates and underwent transapical-transcatheter aortic valve implantation (TA-TAVI). In this study, we included all those patients who failed to be TF candidates and underwent TA-TAVI using the third-generation balloon expandable valve (Edwards SAPIEN 3 valve [S3]) (116 patients; STS score 6.07 ± 4.4; age 79.4 ± 7). RESULTS The incidence of patients unsuitable for TF access at our heart center was 14%. We classified this TAVI population into absolute contraindication for TF access n = 84 (72.5%) and increased interventional risk for TF access n = 32 (27.5%). After TA-TAVI of this specific population using S3, the in-hospital mortality and stroke were 1.7 and 1.7%, respectively. The vascular injury rate was 1.7%. We registered no paravalvular leakage ≥2. The pacemaker rate was 7.4%. The mean transvalvular pressure gradient was 8.7 mm Hg. CONCLUSION The incidence of patients who cannot undergo TF access or who are at high interventional risk is considerably high. TA-TAVI, supported with sufficient interventional experience and appropriate valve system, represents an excellent alternative for patients with distinct vasculopathy.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Department of Medical Statistics, Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
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13
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Hudziak D, Hajder A, Gocol R, Malinowski M, Kazmierski M, Morkisz L, Ciosek J, Wanha W, Jarosinski G, Parma R, Darocha T, Wojakowski W. Long-Term Clinical Outcomes and Carotid Ultrasound Follow-Up of Transcarotid TAVI. Prospective Single-Center Registry. J Clin Med 2021; 10:1499. [PMID: 33916515 PMCID: PMC8038472 DOI: 10.3390/jcm10071499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to prospectively evaluate the safety and long-term clinical outcomes of cerebral-oximetry-guided transcarotid transcatheter aortic valve implantation (TC-TAVI) with systematic follow-up with carotid ultrasound. Thirty-three TCTAVI procedures were performed in our center from 2017 to 2019. Our analysis includes in-hospital outcomes and long-term follow-up data on mortality, echocardiographic parameters, carotid Doppler ultrasound, and VARC-2 defined clinical events. Intraoperatively, one patient died, and one had a transient ischemic attack (TIA). The following events occurred in-hospital postoperatively: myocardial infarction (3.0%), cardiac tamponade (3.0%), new-onset atrial fibrillation (6.3%), need for temporary pacing (27.3%) and need for pacemaker implantation (15%). The mean follow-up was 19.5 ± 9.52 months. In the long-term follow-up, the two-year survival rate was 83% ± 14. The echocardiographic parameters did not differ significantly from the postprocedural values, and the ultrasound did not show any cases of significant vessel narrowing. The mean peak systolic velocity (PSV) was 71.6 cm/s in the left common carotid artery and 70.6 cm/s in the right common carotid artery. In conclusion, cerebral oximetry-guided TC access is safe, has a favorable long-term outcome, and does not increase the risk of plaque formation in the carotid artery. In a carefully selected group of patients, it might be considered as a first-choice alternative to TF access.
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Affiliation(s)
- Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Adrianna Hajder
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Radoslaw Gocol
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Marcin Malinowski
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Maciej Kazmierski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Lukasz Morkisz
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Joanna Ciosek
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Wojciech Wanha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Grzegorz Jarosinski
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-007 Katowice, Poland;
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 40-007 Katowice, Poland;
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
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14
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Marie B, David CH, Guimbretière G, Foucher Y, Buschiazzo A, Letocart V, Manigold T, Plessis J, Jaafar P, Morin H, Rozec B, Roussel JC, Sénage T. Carotid versus femoral access for transcatheter aortic valve replacement: comparable results in the current era. Eur J Cardiothorac Surg 2021; 60:874-879. [PMID: 33724380 DOI: 10.1093/ejcts/ezab109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The carotid approach for transcatheter aortic valve replacement (TAVR) has been shown to be feasible and safe. The goal of this study was to compare the 30-day outcomes of trans-carotid (TC) and transfemoral (TF) TAVR. METHODS This retrospective study enrolled 500 consecutive patients treated by TC-TAVR (n = 100) or TF-TAVR (n = 400) with percutaneous closure between January 2018 and January 2020 at the Nantes University Hospital. The primary end-point was the occurrence of cardiovascular death and cerebrovascular events at 30 days. RESULTS The mean age was 79.9 ± 8.1 in the TC group and 81.3 ± 6.9 (P = 0.069) in the TF group. The TC group had more men (69% vs 50.5%; P = 0.001) and more patients with peripheral vascular disease (86% vs 14.8%; P < 0.0001). Cardiac characteristics were similar between the groups, and the EuroSCORE II was 3.8 ± 2.6% vs 4.6 ± 6.0%, respectively (P = 0.443). The 30-day mortality was 2% in the TC group versus 1% in the TF group (P = 0.345). TC-TAVR was not associated with an increased risk of stroke (2% vs 2.5%; P = 0.999) or major vascular complications (2% vs 4%; P = 0.548). More permanent pacemakers were implanted in the TF group (14.9% vs 5.6%; P = 0.015), and no moderate or severe aortic regurgitation was observed in the TC group (0 vs 3.3%; P = 0.08). TC-TAVR was not associated with an increased risk of mortality or stroke at 30 days (odds ratio 1.32; 95% confidence interval 0.42-4.21; P = 0.63) in the multivariable analysis. CONCLUSIONS No statistically significant differences between TC-TAVR and TF-TAVR were observed; therefore, TC-TAVR should be the first alternative in patients with anatomical contraindications to the femoral route.
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Affiliation(s)
- Basile Marie
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Charles Henri David
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Guillaume Guimbretière
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Yohann Foucher
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Antoine Buschiazzo
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Vincent Letocart
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Thibaut Manigold
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Julien Plessis
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Philippe Jaafar
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Hélène Morin
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Bertrand Rozec
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Jean Christian Roussel
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Thomas Sénage
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
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15
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Reardon MJ. Reply: Boomer or barometer? J Thorac Cardiovasc Surg 2021; 164:e82-e83. [PMID: 33563421 DOI: 10.1016/j.jtcvs.2020.12.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex
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16
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Useini D. What do we know about the indications for a transcarotid approach? J Thorac Cardiovasc Surg 2021; 164:e81. [PMID: 33541729 DOI: 10.1016/j.jtcvs.2020.12.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/19/2020] [Accepted: 12/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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17
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Transcarotid versus transfemoral access in patients undergoing transcatheter aortic valve replacement with complex aortofemoral anatomy. Catheter Cardiovasc Interv 2020; 97:1452-1459. [DOI: 10.1002/ccd.29438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/30/2020] [Indexed: 11/07/2022]
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18
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Folliguet TA, Teiger E, Beurtheret S, Modine T, Lefevre T, Van Belle E, Gilard M, Eltchaninoff H, Koning R, Iung B, Verhoye JP, Leprince P, Le Breton H, Lafont A, Parolari A, Barili F. Carotid versus femoral access for transcatheter aortic valve implantation: a propensity score inverse probability weighting study. Eur J Cardiothorac Surg 2020; 56:1140-1146. [PMID: 31365061 DOI: 10.1093/ejcts/ezz216] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The transcarotid (TC) approach for transcatheter aortic valve implantation (TAVI) is potentially an optimal alternative to the transfemoral (TF) approach. Our goal was to compare the safety and efficacy of TC- and TF-TAVI. METHODS Patients who underwent TF-TAVI or TC-TAVI in the prospectively collected FRANCE TAVI registry between January 2013 and December 2015 were compared. Propensity score inverse probability weighting methods were employed to minimize the impact of bias related to non-random treatment assignment. RESULTS Of the 11 033 patients included in the current study, 10 598 (96%) underwent a TF-TAVI and 435 (4.1%) had a TC-TAVI. Patients in the TC-TAVI access group presented with a higher risk profile but were significantly younger. There were no differences in the perioperative and 2-year mortality rates after adjustment [odds ratio (OR) 1.02, 95% confidence interval (CI) 0.62-1.68; P = 0.99 and hazard ratio 1.03, 95% CI 0.7-1.35; P = 0.83). TC-TAVI was associated with a significant risk of stroke (OR 2.42, 95% CI 2.01-2.92; P < 0.001), ST-elevation myocardial infarction (OR 7.32, 95% CI 3.87-13.87; P < 0.001), infections (OR 2.36, 95% CI 2.04-2.71; P < 0.001), bleeding (OR 2.01, 95% CI 1.76-2.29; P < 0.001), renal failure (OR 2.23, 95% CI 1.90-2.60; P < 0.001) and need for dialysis (OR 2.36, 95% CI 2.01-2.76, P < 0.001). Conversely, TC-TAVI was not confirmed as a risk factor for pacemaker implantation after adjustment (OR 1.05, 95% CI 0.96-1.15; P < 0.28) and was a protective factor for vascular complications (OR 0.37, 95% CI 0.32-0.43; P < 0.001). CONCLUSIONS TC-TAVI is a safe procedure compared to TF-TAVI, although it holds an increased risk of perioperative complications. It should be considered in case of non-femoral peripheral access as the second access choice, to increase the overall safety of TAVI procedures.
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Affiliation(s)
- Thierry A Folliguet
- Department of Cardiac Surgery and Cardiology, Assistance Publique-Hôpitaux de Paris, Hospital Henri Mondor, University Paris 12 UPEC, Creteil, France
| | - Emmanuel Teiger
- Department of Cardiac Surgery and Cardiology, Assistance Publique-Hôpitaux de Paris, Hospital Henri Mondor, University Paris 12 UPEC, Creteil, France
| | | | - Thomas Modine
- Cardiac Surgery Department, Cardiologic University Hospital, Lille, France
| | - Thierry Lefevre
- Paris South Cardio-vascular Institute, Jacques-Cartier Private Hospital, Massy, France
| | - Eric Van Belle
- Department of Cardiology, University of Lille 2, Regional University Hospital Center of Lille, National Institute of Health and Medical Research U1011, University Hospital Federation Integra, Lille, France
| | - Martine Gilard
- Department of Cardiology, La Cavale Blanche University Hospital Center, Optimization of Physiological Regulations, Science and Technical Training and Research Unit, University of Western Brittany, Brest, France
| | - Helene Eltchaninoff
- Cardiology Service, Rouen-Charles-Nicolle University Hospital Center, National Institute of Health and Medical Research U644, Rouen, France
| | - René Koning
- Cardiology Service, Saint Hilaire Clinic, Rouen, France
| | - Bernard Iung
- Department of Cardiology, University Hospital Department and Paris-Diderot University, Public Assistance Hospitals of Paris, Bichat Hospital, Paris, France
| | - Jean Philippe Verhoye
- Thoracic and Cardiovascular Surgery Service, Pontchaillou University Hospital Center, University of Rennes 1, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Pascal Leprince
- Cardiac Surgery Department, Sorbonne-Pierre-et-Marie-Curie University, Public Assistance Hospitals of Paris, Groupe Hospitalier de la Pitié Salpêtrière (GHPS), Paris, France
| | - Hervé Le Breton
- Cardiology and Vascular Diseases Service, Pontchaillou University Hospital Center, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Antoine Lafont
- Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Alessandro Parolari
- Universitary Cardiac Surgery, Policlinico S. Donato IRCCS, University of Milan, Milan, Italy
| | - Fabio Barili
- Department of Cardiovascular Surgery, S. Croce Hospital, Cuneo, Italy
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Sharma SP, Chaudhary R, Ghuneim A, Harder W, David S, Choksi N, Kondur S, Kambhatla S, Kambhatla S, Kondur A. Carotid access for transcatheter aortic valve replacement: A meta‐analysis. Catheter Cardiovasc Interv 2020; 97:723-733. [DOI: 10.1002/ccd.29244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | - Rahul Chaudhary
- Division of Hospital Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Angela Ghuneim
- Department of Cardiology Garden City Hospital Garden City Michigan USA
| | - William Harder
- Department of Cardiology Garden City Hospital Garden City Michigan USA
| | - Shukri David
- Division of Cardiology Ascension Providence Hospital Southfield Michigan USA
| | - Nishit Choksi
- Department of Cardiology Garden City Hospital Garden City Michigan USA
| | - Snigdha Kondur
- Department of Cardiology Garden City Hospital Garden City Michigan USA
| | - Swathi Kambhatla
- Department of Cardiology Garden City Hospital Garden City Michigan USA
| | - Sujata Kambhatla
- Division of Internal Medicine Garden City Hospital Garden City Michigan USA
| | - Ashok Kondur
- Department of Cardiology Garden City Hospital Garden City Michigan USA
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20
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Morello A, Corcione N, Ferraro P, Cimmino M, Pepe M, Cassese M, Frati G, Biondi-Zoccai G, Giordano A. The best way to transcatheter aortic valve implantation: From standard to new approaches. Int J Cardiol 2020; 322:86-94. [PMID: 32814109 DOI: 10.1016/j.ijcard.2020.08.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/07/2020] [Accepted: 08/07/2020] [Indexed: 02/08/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is a safe and beneficial treatment for patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. The safety of the procedure continues to improve thanks to more refined procedural approaches and devices but, also and above all, to the accrual of the procedural knowledge and expertise by the operators. The diversification of the approaches and the possibility to tailor the treatment on the individual needs and anatomical features of the patients allows a rapid learning curve in the management of even complications. Indeed, there are several approaches with which TAVI can be carried out: transfemoral arterial, subclavian, transcarotid, transaortic, transaxillary, transapical, and through right anterior thoracotomy. Although transfemoral venous TAVI is less common, it has already have been carried out using caval-aortic punctures. This field is rapidly evolving, and it will be of paramount importance for interventional cardiologists and cardiothoracic surgeons to keep up to date with further developments. This review intends to give an in-depth and update overview of both conventional and innovative TAVI approaches, with the scope to highlight the relevant advantages, major disadvantages, safety aspects and techniques.
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Affiliation(s)
- Alberto Morello
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy.
| | - Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Paolo Ferraro
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Cimmino
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency and OrganTransplantation, University of Bari, Bari, Italy
| | - Mauro Cassese
- Heart Surgery Department, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; IRCCS NEUROMED, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
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21
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Comparative Outcomes of Transcarotid and Transsubclavian Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2020; 109:49-56. [DOI: 10.1016/j.athoracsur.2019.05.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 11/20/2022]
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22
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Usman MS, Rawasia WF, Siddiqi TJ, Mujeeb FA, Nadeem S, Alkhouli M. Meta-analysis Evaluating the Safety and Efficacy of Transcarotid Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 124:1940-1946. [PMID: 31653356 DOI: 10.1016/j.amjcard.2019.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 12/20/2022]
Abstract
We performed a systemic review and meta-analysis of studies evaluating transcarotid vascular access for transcatheter aortic valve implantation (TAVI). Published studies evaluating transcarotid vascular access for TAVI were included in this analysis. Outcomes of interest included 30-day mortality, stroke/transient ischemic attack (TIA), new pacemaker implantation, acute kidney injury (AKI), major vascular complication, major bleeding, and myocardial infarction. Pooled estimate for 30-day mortality was 5.3% (95% confidence interval [CI] 4.0% to 6.8%; I2 = 4%), stroke/TIA was 3.4% (95% CI 2.4% to 4.6%; I2 = 0%), new pacemaker implantation was 15.3% (95% CI 10.8% to 19.7%; I2 = 72%), AKI was 3.4% (95% CI 1.3% to 6.5%; I2 = 58%), major vascular complication was 2.4% (95% CI 1.1% to 3.7%; I2 = 46%), major bleeding was 4.3% (95% CI 2.8% to 6.1%; I2 = 11%), and myocardial infarction was 1.1% (95% CI 0.4% to 2.0%; I2 = 0%). Metaregression was carried out to study the association of effect size with the continuous study-level covariates that included average age, proportion of males, and mean STS score. In this regard, mean STS score showed association with major vascular complications (coefficient: 0.008; p = 0.049). Cumulative meta-analysis carried out showed that there was temporal trend of decreasing incidence of stroke/TIA, major vascular complications, and AKI for transcarotid TAVI. In conclusion, transcarotid access for TAVI is a reasonable choice in patients requiring alternate access to transfemoral route.
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Affiliation(s)
| | | | | | | | | | - Mohamad Alkhouli
- Mayo Clinic School of Medicine - Mayo Clinic, Rochester, Minnesota.
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Beurtheret S, Karam N, Resseguier N, Houel R, Modine T, Folliguet T, Chamandi C, Com O, Gelisse R, Bille J, Joly P, Barra N, Tavildari A, Commeau P, Armero S, Pankert M, Pansieri M, Siame S, Koning R, Laskar M, Le Dolley Y, Maudiere A, Villette B, Khanoyan P, Seitz J, Blanchard D, Spaulding C, Lefevre T, Van Belle E, Gilard M, Eltchaninoff H, Iung B, Verhoye JP, Abi-Akar R, Achouh P, Cuisset T, Leprince P, Marijon E, Le Breton H, Lafont A. Femoral Versus Nonfemoral Peripheral Access for Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 74:2728-2739. [DOI: 10.1016/j.jacc.2019.09.054] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 11/15/2022]
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Pour-Ghaz I, Raja J, Bayoumi M, Manolukas T, Khouzam RN, Ibebuogu UN. Transcatheter aortic valve replacement with a focus on transcarotid: a review of the current literature. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:420. [PMID: 31660319 DOI: 10.21037/atm.2019.07.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Valve replacement in high-risk patients with severe aortic stenosis has undergone a huge paradigm shift in the recent years in terms of procedural details and vascular access site for patients who have poor peripheral access. Carotid artery is one of the more promising access sites which has been proven to provide a good alternative site with comparable outcomes to transfemoral approach. In this manuscript, we will provide a review of the current literature on transaortic, transapical, transaxillary and transcarotid approaches to transcatheter aortic valve replacement (TAVR) while focusing on the transcarotid approach.
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Affiliation(s)
- Issa Pour-Ghaz
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joel Raja
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mahmoud Bayoumi
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Theodore Manolukas
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Eudailey KW, Olds A, Lewis CT, Nazif TN, Vahl T, Khalique OK, Hahn RT, Bapat V, Borger MA, Leon MB, Ahmed MI, Kodali S, George I. Contemporary suprasternal transcatheter aortic valve replacement: A multicenter experience using a simple, reliable alternative access approach. Catheter Cardiovasc Interv 2019; 95:1178-1183. [DOI: 10.1002/ccd.28460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/20/2019] [Accepted: 08/12/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Kyle W. Eudailey
- Princeton Baptist Medical Center/Brookwood Baptist Health System Birmingham Alabama
| | - Anna Olds
- Department of Surgery, Division of Cardiothoracic SurgeryCollege of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital New York New York
| | - Clifton T. Lewis
- Princeton Baptist Medical Center/Brookwood Baptist Health System Birmingham Alabama
| | - Tamim N. Nazif
- Department of Surgery, Division of Cardiothoracic SurgeryCollege of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital New York New York
| | - Torsten Vahl
- Department of Surgery, Division of Cardiothoracic SurgeryCollege of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital New York New York
| | - Omar K. Khalique
- Department of Surgery, Division of Cardiothoracic SurgeryCollege of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital New York New York
| | - Rebecca T. Hahn
- Department of Medicine, Division of CardiologyCollege of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital New York New York
| | - Vinayak Bapat
- Department of Surgery, Division of Cardiothoracic SurgeryCollege of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital New York New York
| | - Michael A. Borger
- Department of Surgery, Division of Cardiothoracic SurgeryCollege of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital New York New York
| | - Martin B. Leon
- Department of Medicine, Division of CardiologyCollege of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital New York New York
| | - Mustafa I. Ahmed
- Princeton Baptist Medical Center/Brookwood Baptist Health System Birmingham Alabama
| | - Susheel Kodali
- Department of Medicine, Division of CardiologyCollege of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital New York New York
| | - Isaac George
- Department of Surgery, Division of Cardiothoracic SurgeryCollege of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital New York New York
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Beve M, Auffret V, Belhaj Soulami R, Tomasi J, Anselmi A, Roisne A, Boulmier D, Bedossa M, Leurent G, Donal E, Le Breton H, Verhoye JP. Comparison of the Transarterial and Transthoracic Approaches in Nontransfemoral Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 123:1501-1509. [PMID: 30777318 DOI: 10.1016/j.amjcard.2019.01.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
Transfemoral approach stands as the reference access-route for transcatheter aortic valve implantation (TAVI). Nonetheless, alternatives approaches are still needed in a significant proportion of patients. This study aimed at comparing outcomes between transthoracic-approach (transapical or transaortic) and transarterial-approach (transcarotid or subclavian) TAVI. Data from 191 consecutive patients who underwent surgical-approach TAVI from May 2009 to September 2017 were analyzed. Patients were allocated in 2 groups according to the approach. The primary end point was the 30-day composite of death of any cause, need for open surgery, tamponade, stroke, major or life-threatening bleeding, stage 2 or 3 acute kidney injury, coronary obstruction, or major vascular complications. During the study period, 104 patients underwent transthoracic TAVI (transapical: 60.6%, transaortic: 39.4%) whereas 87 patients underwent transarterial TAVI (subclavian: 83.9%, transcarotid: 16.1%). Logistic EuroSCORE I tended to be higher in transthoracic-TAVI recipients. In-hospital and 30-day composite end point rates were 25.0% and 11.5% (p = 0.025), and 26.0% and 14.9% (p = 0.075) for the transthoracic and transarterial cohorts, respectively. Propensity score-adjusted logistic regression demonstrated no significant detrimental association between the 30-day composite end point and transthoracic access (odds ratio 2.12 95% confidence interval 0.70 to 6.42; p = 0.18). Transarterial TAVI was associated with a shorter length of stay (median: 6 vs 7 days, p <0.001). TAVI approach was not an independent predictor of midterm mortality. In conclusion, nontransfemoral transarterial-approach TAVI is safe, feasible, and associated with comparable rates of major perioperative complications, and midterm mortality compared with transthoracic-approach TAVI.
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Overtchouk P, Folliguet T, Pinaud F, Fouquet O, Pernot M, Bonnet G, Hubert M, Lapeze J, Claudel JP, Ghostine S, Azmoun A, Caussin C, Zannis K, Harmouche M, Verhoye JP, Lafont A, Chamandi C, Ruggieri VG, Di Cesare A, Leclercq F, Gandet T, Modine T. Transcarotid Approach for Transcatheter Aortic Valve Replacement With the Sapien 3 Prosthesis. JACC Cardiovasc Interv 2019; 12:413-419. [DOI: 10.1016/j.jcin.2018.11.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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Watanabe M, Takahashi S, Yamaoka H, Sueda T, Piperata A, Zirphile X, Leroux L, Peltan J, Labrousse L. Comparison of Transcarotid vs. Transfemoral Transcatheter Aortic Valve Implantation. Circ J 2018; 82:2518-2522. [DOI: 10.1253/circj.cj-18-0530] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Hironori Yamaoka
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Taijiro Sueda
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | | | | | - Lionel Leroux
- Hôpital Haut-Lévèque, Bordeaux Heart University Hospital
| | - Julien Peltan
- Hôpital Haut-Lévèque, Bordeaux Heart University Hospital
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Hudziak D, Nowak A, Gocoł R, Parma R, Ciosek J, Ochała A, Deja M, Wojakowski W. Prospective registry on cerebral oximetry-guided transcarotid TAVI in patients with moderate-high risk aortic stenosis. Minerva Cardioangiol 2018; 67:11-18. [PMID: 30226033 DOI: 10.23736/s0026-4725.18.04799-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of the study was to assess safety TAVI procedure through the common carotid artery in high-vascular-risk patients. METHODS The approach was selected by a multidisciplinary (cardiologists and cardiac surgeons) heart team after analyzing preoperative coronary angiography, transthoracic echocardiography and multislice contrast computed tomography of the peripheral arteries. Patients with the following conditions were qualified to the transcarotid access: severe peripheral artery disease (stenotic, heavily calcified), tortuous or small diameter <6 mm iliofemoral arteries, descending and abdominal aortic disease. RESULTS Ten transcarotid transcatheter aortic valve implantation procedures were performed in our hospital from September 2017 to May 2018. There were no in-hospital deaths or strokes. The procedural success rate defined as the implantation of the valve with no coronary obstruction and less than moderate paravalvular leak was 100%. Parameters of regional cerebral oximetry were symmetrical on the left and right side in all cases and only during rapid ventricular pacing transiently decreased below the value of 50%. Postoperative cerebrovascular complications and myocardial infarctions were not observed. Statistically significant reduction of the echocardiographic parameters (PGmax and PGmean, Vmax) were observed. Mild paravalvular leaks occurred in 4 patients. Additionally, the heart failure symptoms diminished after the procedure from a median class III to class II. In the 3-month follow-up, mortality is 10% (unknown cause of death of one patient). The mean NYHA class of the other patients is II. Echocardiographic parameters are comparable to postoperative day 4. CONCLUSIONS The pilot registry showed the safety of transcarotid approach in patients with the anatomy precluding the transfemoral approach.
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Affiliation(s)
- Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland -
| | - Adrianna Nowak
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Radosław Gocoł
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Radosław Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Joanna Ciosek
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Andrzej Ochała
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Marek Deja
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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Lanz J, Greenbaum A, Pilgrim T, Tarantini G, Windecker S. Current state of alternative access for transcatheter aortic valve implantation. EUROINTERVENTION 2018; 14:AB40-AB52. [DOI: 10.4244/eij-d-18-00552] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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