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Abdelnour MW, Patel V, Patel PM, Kasel AM, Frangieh AH. Alternative access in transcatheter aortic valve replacement-an updated focused review. Front Cardiovasc Med 2024; 11:1437626. [PMID: 39175626 PMCID: PMC11338806 DOI: 10.3389/fcvm.2024.1437626] [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: 05/24/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024] Open
Abstract
Aortic Stenosis (AS) is a common condition with an estimated pooled prevalence of all AS in the elderly population at around 12.4%, with that of severe AS estimated to be around 3.4%. In the past, surgical aortic valve replacement was the primary treatment option for severe AS for decades. However, with the compelling evidence on the safety and efficacy of transcatheter aortic valve replacement (TAVR), it has become the gold standard treatment option for many patients with symptomatic severe AS. Transfemoral access has been the preferred method for transcatheter heart valve delivery. However, the prevalent use of TAVR on a diverse patient profile with different risk factors, such as peripheral artery disease, precluded the possibility of a transfemoral approach despite the improvement of valves and delivery systems technology. Therefore, alternative TAVR approaches have gained increasing utility in cases where transfemoral access is unfavorable. We review the journey, evolution, and techniques for different approaches of percutaneous TAVR, including transfemoral, transcarotid, transsubclavian/transaxillary, and transcaval approaches, in addition to the traditional "surgical" transaortic and transapical accesses. Consolidating these data highlights each approach's practicality and limitations, providing additional grounding for case-by-case utilization and future clinical research.
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Affiliation(s)
- Mark W. Abdelnour
- Division of Cardiology, Department of Medicine, University of California Irvine Medical Center, Orange, California, CA, United States
| | - Vishal Patel
- Division of Cardiology, Department of Medicine, University of California Irvine Medical Center, Orange, California, CA, United States
| | - Pranav M. Patel
- Division of Cardiology, Department of Medicine, University of California Irvine Medical Center, Orange, California, CA, United States
| | - A. M. Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Antonio H. Frangieh
- Division of Cardiology, Department of Medicine, University of California Irvine Medical Center, Orange, California, CA, United States
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Abellan C, Antiochos P, Fournier S, Skali H, Shah P, Maurizi N, Eeckhout E, Roguelov C, Monney P, Tzimas G, Kirsch M, Muller O, Lu H. Extrathoracic Against Intrathoracic Vascular Accesses for Transcatheter Aortic Valve Replacement: A Systematic Review With Meta-Analysis. Am J Cardiol 2023; 203:473-483. [PMID: 37633682 DOI: 10.1016/j.amjcard.2023.07.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/14/2023] [Indexed: 08/28/2023]
Abstract
Alternative vascular accesses to transfemoral access for transcatheter aortic valve replacement (TAVR) can be divided into intrathoracic (IT)-transapical and transaortic- and extrathoracic (ET)-transcarotid, transsubclavian, and transaxillary. This study aimed to compare the outcomes and safety of IT and ET accesses for TAVR as alternatives to transfemoral access. A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all studies comparing IT-TAVR with ET-TAVR published until April 2023. Outcomes included in-hospital or 30-day all-cause mortality (ACM), 1-year ACM, postoperative and 30-day complications. A total of 18 studies with 6,800 IT-TAVR patients and 5,032 ET-TAVR patients were included. IT accesses were associated with a significantly higher risk of in-hospital or 30-day ACM (relative risk 1.99, 95% confidence interval 1.67 to 2.36, p <0.001), and 1-year ACM (relative risk 1.31, 95% confidence interval 1.21 to 1.42, p <0.001). IT-TAVR patients presented more often with postoperative life-threatening bleeding, 30-day new-onset atrial fibrillation or flutter, and 30-day acute kidney injury needing renal replacement therapy. The risks of postoperative permanent pacemaker implantation and significant paravalvular leak were lower with IT-TAVR. ET-TAVR patients were more likely to be directly discharged home. There was no statistically significant difference regarding the 30-day risk of stroke. Compared with ET-TAVR, IT-TAVR was associated with higher risks of in-hospital or 30-day ACM, 1-year ACM and higher risks for some critical postprocedural and 30-day complications. Our results suggest that ET-TAVR could be considered as the first-choice alternative approach when transfemoral access is contraindicated.
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Affiliation(s)
- Christophe Abellan
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Panagiotis Antiochos
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pinak Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Niccolo Maurizi
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christan Roguelov
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgios Tzimas
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Service of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henri Lu
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Clinical outcomes following transapical TAVR with ACURATE neo in the CHANGE neo TA study. IJC HEART & VASCULATURE 2021; 36:100862. [PMID: 34504944 PMCID: PMC8411222 DOI: 10.1016/j.ijcha.2021.100862] [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] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
Background A transapical (TA) approach to transcatheter aortic valve replacement (TAVR) may be used when a transfemoral (TF) approach is not feasible. The CHANGE neo TA study evaluated patients treated in routine clinical practice via TA-TAVR with the ACURATE neo bioprosthetic aortic valve. Methods and results This single-arm post-market study had a planned enrolment of 200 subjects; enrolment was terminated early due to declining TA-TAVR procedures at participating centers. Final enrolment was 107 patients (mean age: 79.3 years; 54.2% female; mean STS score at baseline: 6.2%). The mortality rate in the intent-to-treat population was 11.2% at 30 days (primary endpoint) and 25.6% at 12 months. The VARC-2 composite endpoint for 30-day safety occurred in 24.3% of patients. Six patients (5.6%) received a permanent pacemaker within 30 days. Site-reported echocardiographic data showed early improvements in mean aortic valve gradient (baseline: 38.8 [SD 13.1] mmHg, discharge: 6.7 [SD 3.7] mmHg) and effective orifice area (baseline: 0.7 [SD 0.2] cm2, discharge: 1.9 [SD 0.6] cm2), and the discharge rate of paravalvular regurgitation was low (74.7% none/trace, 24.2% mild, 1.1% severe). Conclusions TA-TAVR with the ACURATE neo valve system yields acceptable clinical outcomes, providing an alternative for patients with aortic stenosis who are not candidates for TF-TAVR.
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Bocchino PP, Angelini F, Alushi B, Conrotto F, Cioffi GM, Tersalvi G, Senatore G, Pedrazzini G, De Ferrari GM, Biasco L. Transcatheter Aortic Valve Replacement in Young Low-Risk Patients With Severe Aortic Stenosis: A Review. Front Cardiovasc Med 2021; 7:608158. [PMID: 33381528 PMCID: PMC7767870 DOI: 10.3389/fcvm.2020.608158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
In the last decades, transcatheter aortic valve replacement (TAVR) revolutionized the treatment of symptomatic severe aortic stenosis. The efficacy and safety of TAVR were first proven in inoperable and high-risk patients. Then, subsequent randomized clinical trials showed non-inferiority of TAVR as compared to surgical aortic valve replacement also in intermediate- and low-risk populations. As TAVR was progressively studied and clinically used in lower-risk patients, issues were raised questioning its opportunity in a younger population with a longer life-expectancy. As long-term follow-up data mainly derive from old studies with early generation devices on high or intermediate surgical risk patients, results can hardly be extended to most of currently treated patients who often show a low surgical risk and are treated with newer generation prostheses. Thus, in this low-risk younger population, decision making is difficult due to the lack of supporting data. The aim of the present review is to revise current literature regarding TAVR in younger patients.
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Affiliation(s)
- Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Brunilda Alushi
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Erfurt, Germany.,Department of Cardiology, Campus Benjamin Franklin, Charite' Medical University Berlin, Berlin, Germany
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Giacomo Maria Cioffi
- Department of Cardiology, Kantonsspital Luzern, Lucerne, Switzerland.,Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Gregorio Tersalvi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Gaetano Senatore
- Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy
| | - Giovanni Pedrazzini
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Luigi Biasco
- Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
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Khan MR, Kayani WT, Manan M, Munir A, Hamzeh I, Virani SS, Birnbaum Y, Jneid H, Alam M. Comparison of surgical versus transcatheter aortic valve replacement for patients with aortic stenosis at low-intermediate risk. Cardiovasc Diagn Ther 2020; 10:135-144. [PMID: 32420093 DOI: 10.21037/cdt.2020.02.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background To compare safety and efficacy of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients at low-intermediate risk, given the paucity of robust data. Methods We performed an aggregate data meta-analysis of 7 randomized controlled trials (RCTs) and 6,778 patients comparing TAVR with SAVR for aortic stenosis (AS) in low-intermediate risk patients (Society of Thoracic Surgeons risk-score ≤8%) using the random-effects model. Primary outcome was all-cause mortality at 30-day, 1-year and 2-year of follow-up. Secondary outcomes included cardiac-mortality, stroke, acute kidney injury (AKI), atrial fibrillation (AF), permanent pacemaker (PPM) implantation, major-bleeding, moderate-severe paravalvular regurgitation (PVR) and rehospitalization. Results All-cause mortality, cardiac-mortality and stroke were comparable between the two groups. AF was higher with SAVR at 30-day [odds ratio (OR) 0.17, 95% confidence intervals (CI): 0.12-0.24] thorough to 2-year (OR 0.34, 95% CI: 0.21-0.55), while PPM implantation was higher with TAVR (30-day: OR 3.31, 95% CI: 1.64-6.66, 2-year: OR 3.17, 95% CI: 1.02-9.86). Moderate-severe PVR was more prevalent with TAVR at all follow-ups. On inter-group comparison, patients in the low-risk group had an even lower risk of AF, but a higher risk of PPM implantation as compared to the patients in the intermediate-risk group undergoing TAVR. Conclusions Compared to SAVR, TAVR had comparable all-cause mortality and stroke, lower-risk of AF, but was associated with a higher risk of PPM implantation and moderate-severe PVR in low-intermediate-risk patients. Thus, highlighting the need for longer-term follow-up before robust inferences are drawn.
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Affiliation(s)
- Mahin R Khan
- Division of Cardiology, McLaren-Flint/Michigan State University, Flint, MI, USA
| | - Waleed T Kayani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Ahmad Munir
- Division of Cardiology, McLaren-Flint/Michigan State University, Flint, MI, USA
| | - Ihab Hamzeh
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Salim S Virani
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Yochai Birnbaum
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hani Jneid
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Mahboob Alam
- Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
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D'Ascenzo F, Verardi R, Visconti M, Conrotto F, Scacciatella P, Dziewierz A, Stefanini GG, Paradis JM, Omedè P, Kodali S, D'Amico M, Rinaldi M, Salizzoni S. Independent impact of extent of coronary artery disease and percutaneous revascularisation on 30-day and one-year mortality after TAVI: a meta-analysis of adjusted observational results. EUROINTERVENTION 2018; 14:e1169-e1177. [DOI: 10.4244/eij-d-18-00098] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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D'Ascenzo F, Benedetto U, Bianco M, Conrotto F, Moretti C, D'Onofrio A, Agrifoglio M, Colombo A, Ribichini F, Tarantini G, D'Amico M, Salizzoni S, Rinaldi M. Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI. EUROINTERVENTION 2017; 13:e1392-e1400. [PMID: 28870875 DOI: 10.4244/eij-d-17-00198] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The safety and efficacy of single vs. dual antiplatelet therapy (DAPT) in patients undergoing TAVI remain to be addressed. The aim of our study was to evaluate the usefulness of a DAPT compared to a single platelet therapy in patients undergoing TAVI with a balloon-expandable prosthesis. METHODS AND RESULTS All consecutive patients enrolled in the ITER registry were included. Patients undergoing TAVI discharged with aspirin alone were compared to those taking DAPT before and after selection using propensity score with matching. Subgroup analysis was performed for those on OAT. Prosthetic heart valve dysfunction at follow-up was the primary endpoint, whereas all-cause death, cardiovascular death, bleedings, vascular complications and cerebrovascular accidents were the secondary ones. From 1,364 patients, after propensity score with matching, 605 were selected for each group (aspirin alone vs. DAPT). At 30 days, rates of VARC mortality were lower in patients with aspirin alone (1.5% vs. 4.1%, p=0.003), mainly driven by a reduction of major vascular complications (5.3% vs. 10.7%, p<0.001) and of major bleedings (6.6% vs. 11.5%, p<0.001), without a difference in prosthetic heart valve dysfunction after 45±14 months (2.8% vs. 3.0%, p=0.50). These results were confirmed on multivariable analysis. CONCLUSIONS After TAVI with a balloon-expandable prosthesis, aspirin alone does not increase the risk of prosthetic valve dysfunction, and reduces the risk of periprocedural complications and of 30-day all-cause death.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy
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Ando T, Takagi H, Grines CL. Transfemoral, transapical and transcatheter aortic valve implantation and surgical aortic valve replacement: a meta-analysis of direct and adjusted indirect comparisons of early and mid-term deaths. Interact Cardiovasc Thorac Surg 2017; 25:484-492. [PMID: 28549125 DOI: 10.1093/icvts/ivx150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/06/2017] [Indexed: 11/13/2022] Open
Abstract
Clinical outcomes of transfemoral-transcatheter aortic valve implantation (TF-TAVI) versus surgical aortic valve replacement (SAVR) or transapical (TA)-TAVI are limited to a few randomized clinical trials (RCTs). Because previous meta-analyses only included a limited number of adjusted studies or several non-adjusted studies, our goal was to compare and summarize the outcomes of TF-TAVI vs SAVR and TF-TAVI vs TA-TAVI exclusively with the RCT and propensity-matched cohort studies with direct and adjusted indirect comparisons to reach more precise conclusions. We hypothesized that TF-TAVI would offer surgical candidates a better outcome compared with SAVR and TA-TAVI because of its potential for fewer myocardial injuries. A literature search was conducted through PUBMED and EMBASE through June 2016. Only RCTs and propensity-matched cohort studies were included. A direct meta-analysis of TF-TAVI vs SAVR, TA-TAVI vs SAVR and TF-TAVI vs TA-TAVI was conducted. Then, the effect size of an indirect meta-analysis was calculated from the direct meta-analysis. The effect sizes of direct and indirect meta-analyses were then combined. A random-effects model was used to calculate the hazards ratio and the odds ratio with 95% confidence intervals. Early (in-hospital or 30 days) and mid-term (≥1 year) all-cause mortality rates were assessed. Our search resulted in 4 RCTs (n = 2319) and 14 propensity-matched cohort (n = 7217) studies with 9536 patients of whom 3471, 1769 and 4296 received TF, TA and SAVR, respectively. Direct meta-analyses and combined direct and indirect meta-analyses of early and mid-term deaths with TF-TAVI and SAVR were similar. Early deaths with TF-TAVI vs TA-TAVI were comparable in direct meta-analyses (odds ratio 0.64, P = 0.35) and direct and indirect meta-analyses combined (odds ratio 0.73, P = 0.24). Mid-term deaths with TF-TAVI vs TA-TAVI were increased (hazard ratio 0.83, P = 0.07) in a direct meta-analysis and became significant after addition of the indirect meta-analysis (hazard ratio 0.78, 95% confidence interval 0.67-0.92, P = 0.003). In conclusion, TF-TAVI was associated with similar early and mid-term deaths compared with SAVR. The number of early deaths was not significantly different between TF-TAVI and TA-TAVI, whereas there were fewer mid-term deaths with TF-TAVI than with TA-TAVI.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Cindy L Grines
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
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Paim L, Fonseca JHPD, Arruda FVD, Gutierrez PS, Moreira LFP, Jatene FB. A New Experimental Device for Transapical Access of the Aortic and Mitral Valves as well as the Aorta in its Various Segments. Braz J Cardiovasc Surg 2017; 32:156-161. [PMID: 28832792 PMCID: PMC5570386 DOI: 10.21470/1678-9741-2017-0013] [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: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 11/26/2022] Open
Abstract
Objective To present the results of a new experimental device developed to facilitate
the transapical access in endovascular treatment of structural heart
diseases. It aims to reduce the risk of bleeding and complications in this
type of access and demonstrate the device as a safe, fast and effective
alternative. Methods CorPoint is composed of three parts: introducer, base with coiled spring, and
closing capsule. By rotating movements, the spring is introduced into the
myocardium and progressively approaches the base to the surface of the
heart. Guidewires and catheters are inserted through the hollow central part
and, at the end of the procedure, the capsule is screwed over the base,
therefore stopping any bleeding. Results The device was implanted in 15 pigs, weighing 60 kg each, through an
anterolateral thoracotomy, while catheters were introduced and guided by
fluoroscopy. All animals had minimal bleeding; introducers with diameter up
to 22 Fr were used and various catheters and guidewires were easily handled.
After finishing the procedure, the closing capsule was attached and no
bleeding was observed at the site. Conclusion This new device has proved effective, fast and secure for the transapical
access. This shows great potential for use, especially by ensuring an easier
and direct access to the mitral and aortic valves; the shortest distance to
be traveled by catheters; access to the ascending and descending aorta;
decreased bleeding complications; decreased surgical time; and the
possibility of allowing the technique to evolve and become totally
percutaneous.
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Affiliation(s)
- Leonardo Paim
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - José Honório Palma da Fonseca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Francismar Vidal de Arruda
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Paulo Sampaio Gutierrez
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Felipe Pinho Moreira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Michel J, Frangieh AH, Ott I, Kasel AM. Bending the Rules in Transfemoral TAVI With the SAPIEN 3: Overcoming Severe Iliac Tortuosity. Heart Lung Circ 2017; 26:e50-e53. [PMID: 28377229 DOI: 10.1016/j.hlc.2017.02.007] [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: 11/03/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
Whilst the worldwide uptake of transcatheter aortic valve implantation (TAVI) over the last 10 years has been dramatic, iliac tortuosity remains a potential barrier to the most commonly chosen access route via the femoral artery. We describe the challenges posed by severe iliac tortuosity during transfemoral TAVI and contrast a difficult procedure - at the limit of the capability of current device delivery technology - with a straightforward implantation. The use of pre-procedural multi-detector computed tomography to assess the vasculature and a bilateral stiff wire technique for managing iliofemoral tortuosity are discussed.
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Affiliation(s)
| | | | - Ilka Ott
- Deutsches Herzzentrum München, Munich, Bavaria, Germany
| | - A M Kasel
- Deutsches Herzzentrum München, Munich, Bavaria, Germany
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Giordano A, Corcione N, Biondi-Zoccai G, Berti S, Petronio AS, Pierli C, Presbitero P, Giudice P, Sardella G, Bartorelli AL, Bonmassari R, Indolfi C, Marchese A, Brscic E, Cremonesi A, Testa L, Brambilla N, Bedogni F. Patterns and trends of transcatheter aortic valve implantation in Italy. J Cardiovasc Med (Hagerstown) 2017; 18:96-102. [PMID: 27898500 DOI: 10.2459/jcm.0000000000000489] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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12
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Ruparelia N, Panoulas VF, Frame A, Ariff B, Sutaria N, Fertleman M, Cousins J, Anderson J, Bicknell C, Chukwuemeka A, Sen S, Malik IS, Colombo A, Mikhail GW. Impact of clinical and procedural factors upon C reactive protein dynamics following transcatheter aortic valve implantation. World J Cardiol 2016; 8:425-431. [PMID: 27468335 PMCID: PMC4958693 DOI: 10.4330/wjc.v8.i7.425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/24/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the effect of procedural and clinical factors upon C reactive protein (CRP) dynamics following transcatheter aortic valve implantation (TAVI).
METHODS: Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals (Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom and San Raffaele Scientific Institute, Milan, Italy) were included. Daily venous plasma CRP levels were measured for up to 7 d following the procedure (or up to discharge). Procedural factors and 30-d safety outcomes according to the Valve Academic Research Consortium 2 definition were collected.
RESULTS: Following TAVI, CRP significantly increased reaching a peak on day 3 of 87.6 ± 5.5 mg/dL, P < 0.001. Patients who developed clinical signs and symptoms of sepsis had significantly increased levels of CRP (P < 0.001). The presence of diabetes mellitus was associated with a significantly higher peak CRP level at day 3 (78.4 ± 3.2 vs 92.2 ± 4.4, P < 0.001). There was no difference in peak CRP release following balloon-expandable or self-expandable TAVI implantation (94.8 ± 9.1 vs 81.9 ± 6.9, P = 0.34) or if post-dilatation was required (86.9 ± 6.3 vs 96.6 ± 5.3, P = 0.42), however, when pre-TAVI balloon aortic valvuloplasty was performed this resulted in a significant increase in the peak CRP (110.1 ± 8.9 vs 51.6 ± 3.7, P < 0.001). The development of a major vascular complication did result in a significantly increased maximal CRP release (153.7 ± 11.9 vs 83.3 ± 7.4, P = 0.02) and there was a trend toward a higher peak CRP following major/life-threatening bleeding (113.2 ± 9.3 vs 82.7 ± 7.5, P = 0.12) although this did not reach statistical significance. CRP was not found to be a predictor of 30-d mortality on univariate analysis.
CONCLUSION: Careful attention should be paid to baseline clinical characteristics and procedural factors when interpreting CRP following TAVI to determine their future management.
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Ramakrishna H, Patel PA, Gutsche JT, Vallabhajosyula P, Spitz W, Feinman JW, Shah R, Zhou E, Weiss SJ, Augoustides JG. Transcatheter Aortic Valve Replacement: Clinical Update on Access Approaches in the Contemporary Era. J Cardiothorac Vasc Anesth 2016; 30:1425-9. [PMID: 27468895 DOI: 10.1053/j.jvca.2016.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, Arizona
| | | | | | - Prashanth Vallabhajosyula
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Ronak Shah
- Department of Anesthesiology and Critical Care
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Wiegerinck EMA, Van Kesteren F, Van Mourik MS, Vis MM, Baan J. An up-to-date overview of the most recent transcatheter implantable aortic valve prostheses. Expert Rev Med Devices 2016; 13:31-45. [PMID: 26567756 DOI: 10.1586/17434440.2016.1120665] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past decade transcatheter aortic valve implantation (TAVI) has evolved towards the routine therapy for high-risk patients with severe aortic valve stenosis. Technical refinements in TAVI are rapidly evolving with a simultaneous expansion of the number of available devices. This review will present an overview of the current status of development of TAVI-prostheses; describes the technical features and applicability of each device and the clinical data available.
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Affiliation(s)
- Esther M A Wiegerinck
- a Heart Center, Academic Medical Center , University of Amsterdam , Amsterdam , the Netherlands
| | - Floortje Van Kesteren
- a Heart Center, Academic Medical Center , University of Amsterdam , Amsterdam , the Netherlands
| | - Martijn S Van Mourik
- a Heart Center, Academic Medical Center , University of Amsterdam , Amsterdam , the Netherlands
| | - Marije M Vis
- a Heart Center, Academic Medical Center , University of Amsterdam , Amsterdam , the Netherlands
| | - Jan Baan
- a Heart Center, Academic Medical Center , University of Amsterdam , Amsterdam , the Netherlands
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15
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Transfemoral transcatheter aortic valve implantation in patients with small diseased peripheral vessels. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:326-30. [DOI: 10.1016/j.carrev.2015.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/24/2015] [Accepted: 05/28/2015] [Indexed: 12/20/2022]
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16
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Lindsay AC, Mohiaddin RH. The emerging roles of cardiovascular magnetic resonance imaging in transcatheter aortic valve implantation (TAVI). EUROINTERVENTION 2015; 11:137-9. [PMID: 26093836 DOI: 10.4244/eijv11i2a26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alistair C Lindsay
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
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17
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Van Linden A, Doss M, Arsalan M, Kim WK, Walther T. Transcatheter aortic valve implantation--update and evidence. MINIM INVASIV THER 2015; 24:255-63. [PMID: 25966964 DOI: 10.3109/13645706.2015.1047852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Transcatheter aortic valve implantation (T-AVI) has become the standard of care for high-risk patients suffering from severe aortic valve stenosis. More than 60,000 implants have been performed to date. While the first-generation T-AVI devices had some specific issues, the advancements in these first-generation devices and the development of second-generation devices significantly reduced the incidence of peri-procedural complications. The two major access routes are the transfemoral (TF) and the transapical (TA) approach. Both approaches have their advantages and should be considered equal alternatives for finding the best treatment option for the individual patient. Currently there are discussions about extending the indication to patients with lower risk profiles. However, there is no real evidence to justify an expansion, as results of surgical aortic valve replacement in low and intermediate risk patients are excellent.
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Affiliation(s)
- Arnaud Van Linden
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Mirko Doss
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Mani Arsalan
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Won Keun Kim
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany.,b 2 Department of Cardiology, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
| | - Thomas Walther
- a 1 Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim , Bad Nauheim, Germany
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18
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Ruparelia N, Prendergast BD. Indications for transcatheter aortic valve implantation--now and next? MINIM INVASIV THER 2015; 24:264-73. [PMID: 25827477 DOI: 10.3109/13645706.2015.1031680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aortic stenosis (AS) is the most common valvular pathology and its prevalence is expected to increase rapidly in coming decades as a consequence of the increasingly elderly population. Without treatment, severe symptomatic AS has a very poor prognosis with a mortality of 50% at two years. Whilst surgical aortic valve replacement is the gold standard treatment, a significant minority of patients are deemed inoperable and declined surgery due to prohibitively high risk. The advent of transcatheter aortic valve implantation (TAVI) has revolutionised their treatment. In this review, we discuss current indications for TAVI, other applications of this technology and future indications.
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Affiliation(s)
- Neil Ruparelia
- a 1Oxford Heart Centre, John Radcliffe Hospital , Oxford, UK
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D'Ascenzo F, Capodanno D, Tarantini G, Nijhoff F, Ciuca C, Rossi ML, Brambilla N, Barbanti M, Napodano M, Stella P, Saia F, Ferrante G, Tamburino C, Gasparetto V, Agostoni P, Marzocchi A, Presbitero P, Bedogni F, Cerrato E, Omedè P, Conrotto F, Salizzoni S, Biondi Zoccai G, Marra S, Rinaldi M, Gaita F, D'Amico M, Moretti C. Usefulness and validation of the survival posT TAVI score for survival after transcatheter aortic valve implantation for aortic stenosis. Am J Cardiol 2014; 114:1867-74. [PMID: 25438915 DOI: 10.1016/j.amjcard.2014.09.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 02/08/2023]
Abstract
Surgical risk scores fail to accurately predict mortality after transcatheter aortic valve implantation (TAVI). The aim of this study was to develop and validate a dedicated risk score for accurate estimation of mortality risk in these patients. All consecutive patients who underwent TAVI at 6 international institutions were enrolled. Predictors for 1-year all-cause mortality were identified by means of Cox multivariate analysis and incorporated in a prediction score. Accuracy of the score was derived and externally validated for 30-day and 1-year mortality. The net classification improvement compared with the Society of Thoracic Surgeons (STS) score was appraised. A total of 1,064 patients constituted the derivation cohort and 180 patients constituted the external validation cohort. A total of 165 patients (15%) died at 1-year follow-up. Previous stroke (odds ratio [OR] 1.80, 1.4 to 3), inverse of renal clearance (OR 8, 6 to 14), and systolic pulmonary arterial pressure ≥50 mm Hg (OR 2.10, 1.5 to 3) were independently related to 1-year mortality. Area under the curve (AUC) of the survival post TAVI (STT) for 1-year mortality was 0.68 (0.62 to 0.71). At 30 days, 65 patients (7%) had died and the AUC for the STT at this time point was 0.66 (0.64 to 0.75). In the external validation cohorts, the AUC of the STT were 0.66 (0.56 to 0.7) for 30-day and 0.67 (0.62 to 0.71) for 1-year mortality. Net reclassification improvement for STT compared with STS was 31% (p <0.001) for 30-day mortality and 14% (p <0.001) for 1-year mortality. In conclusion, the STT score represents an easy and accurate tool to assess the risk of short-term and mid-term mortality in patients undergoing TAVI.
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20
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[Transcatheter aortic valve implantation]. Ann Cardiol Angeiol (Paris) 2014; 63:422-7. [PMID: 25450991 DOI: 10.1016/j.ancard.2014.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As the French population is aging, a growing number of elderly patients with symptomatic severe aortic stenosis are going to require therapeutic management. Approximately 30 to 40 % of these patients do not undergo surgical treatment and a high proportion is considered to be at high risk for surgery. The transluminal aortic valve implantation technique has been increasingly used over the past few years, thus providing a solution to a major therapeutic issue in our industrialized countries. Thanks to major randomized studies such as the PARTNER US trial, this treatment has been approved for high-risk patients. Expertise and new devices are now opening the way to intermediate risk population.
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