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Purmessur R, Ahmed Z, Ali J. Exploring Optimal Strategies for Surgical Access in Transcatheter Aortic Valve Implantation. J Clin Med 2024; 13:4655. [PMID: 39200796 PMCID: PMC11354912 DOI: 10.3390/jcm13164655] [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: 06/22/2024] [Revised: 07/23/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionised the management of severe aortic stenosis, particularly for patients deemed high risk or inoperable for traditional surgical aortic valve replacement. The transfemoral approach is the preferred route whenever feasible, attributed to its minimally invasive nature, reduced procedural morbidity, and shorter recovery times. In total, 80-90% of TAVI procedures are performed via the transfemoral route. However, anatomical constraints such as severe peripheral arterial disease, small vessel diameter, or significant vessel tortuosity can preclude the use of this access site. In such cases, alternative access strategies must be considered to ensure the successful implantation of the valve. This review aims to provide a comprehensive summary of the various surgical techniques available for TAVI access, exploring the rationale, technical aspects, and challenges associated with each method. We will explore alternative routes, including the transapical, transaortic, transaxillary, and transcarotid approaches, highlighting their respective benefits and limitations.
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Affiliation(s)
- Rushmi Purmessur
- Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK;
| | - Zeba Ahmed
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Jason Ali
- Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK;
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2
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van Wely M, van Nieuwkerk AC, Rooijakkers M, van der Wulp K, Gehlmann H, Verkroost M, van Garsse L, Geuzebroek G, Baz JA, Tchétché D, De Brito FS, Barbanti M, Kornowski R, Latib A, D'Onofrio A, Ribichini F, Dangas G, Mehran R, Delewi R, van Royen N. Transaxillary versus transfemoral access as default access in TAVI: A propensity matched analysis. Int J Cardiol 2024; 394:131353. [PMID: 37696359 DOI: 10.1016/j.ijcard.2023.131353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/10/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Transfemoral (TF) access is default in transcatheter aortic valve implantation (TAVI). Transaxillary (TAx) access has been shown to be a safe alternative in case of prohibitive iliofemoral anatomy, but whether TAx as preferred access has similar safety and efficacy as TF access is unknown. The aim of this study was to compare outcomes between patients treated with self-expanding devices using TF or TAx route as preferred access in TAVI. METHODS A single center cohort of 354 patients treated using TAx as preferred access and a multi-center cohort of 5980 patients treated using TF access were compared. Propensity score matching was used to reduce selection bias and potential confounding. After propensity score matching, each group consisted of 322 patients. Clinical outcomes according to VARC-2 were compared using chi-square test. RESULTS In 6334 patients undergoing TAVI, mean age was 81.4 ± 7.0 years, 57% was female and median logistic EuroSCORE was 14.7% (IQR 9.5-22.6). In the matched population (age 79.3 ± 7.0, 50% female, logistic EuroSCORE 13.4%, IQR 9.0-21.5), primary outcomes 30-day and one-year all-cause mortality were similar between Tax and TF groups (30 days: 5% versus 6%, p = 0.90; 1 year: 20% versus 16%, p = 0.17). Myocardial infarction was more frequent in patients undergoing Tax TAVI compared with TF (4% versus 1%, p = 0.05), but new permanent pacemakers were less frequently implanted (12% versus 21%, p = 0.001). CONCLUSION TAx as preferred access is feasible and safe with outcomes that are comparable to TF access.
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Affiliation(s)
- Marleen van Wely
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Astrid C van Nieuwkerk
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Maxim Rooijakkers
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Kees van der Wulp
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Helmut Gehlmann
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Michel Verkroost
- Department of Cardio-Thoracic surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Leen van Garsse
- Department of Cardio-Thoracic surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Guillaume Geuzebroek
- Department of Cardio-Thoracic surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - José Antonio Baz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | | | - Fabio S De Brito
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy.
| | - Ran Kornowski
- Rabin Medical Center, Cardiology Department, Petach Tikva, Israel.
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Montefiore Medical Center, Department of Interventional Cardiology, New York, USA.
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Ronak Delewi
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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Katsaros O, Apostolos A, Ktenopoulos N, Koliastasis L, Kachrimanidis I, Drakopoulou M, Korovesis T, Karanasos A, Tsalamandris S, Latsios G, Synetos A, Tsioufis K, Toutouzas K. Transcatheter Aortic Valve Implantation Access Sites: Same Goals, Distinct Aspects, Various Merits and Demerits. J Cardiovasc Dev Dis 2023; 11:4. [PMID: 38248874 PMCID: PMC10817029 DOI: 10.3390/jcdd11010004] [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: 11/14/2023] [Revised: 12/03/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been established as a safe and efficacious treatment for patients with severe symptomatic aortic stenosis (AS). Despite being initially developed and indicated for high-surgical-risk patients, it is now offered to low-risk populations based on the results of large randomized controlled trials. The most common access sites in the vast majority of patients undergoing TAVI are the common femoral arteries; however, 10-20% of the patients treated with TAVI require an alternative access route, mainly due to peripheral atherosclerotic disease or complex anatomy. Hence, to achieve successful delivery and implantation of the valve, several arterial approaches have been studied, including transcarotid (TCr), axillary/subclavian (A/Sc), transapical (TAp), transaortic (TAo), suprasternal-brachiocephalic (S-B), and transcaval (TCv). This review aims to concisely summarize the most recent literature data and current guidelines as well as evaluate the various access routes for TAVI, focusing on the indications, the various special patient groups, and the advantages and disadvantages of each technique, as well as their adverse events.
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Affiliation(s)
- Odysseas Katsaros
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
- Department of Cardiology, University of Brussels, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Ioannis Kachrimanidis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Theofanis Korovesis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Antonios Karanasos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Sotirios Tsalamandris
- Department of Cardiology, Hippokration General Hospital of Athens, 11527 Athens, Greece;
| | - George Latsios
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
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Cafaro A, Spione F, Burattini O, De Feo D, Xhelo A, Palmitessa C, D’Alessandro M, Amendola VP, Rimmaudo F, Guaricci AI, Bortone AS, Pestrichella V, Contegiacomo G, Tesorio T, Colonna G, Iacovelli F. Fluoroscopy Time as a New Predictor of Short-Term Outcomes after Transcatheter Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:459. [PMID: 37998517 PMCID: PMC10671838 DOI: 10.3390/jcdd10110459] [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: 06/30/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an almost totally cine-fluoroscopic guided procedure. The amount of radiation used during the procedure is strictly related to the fluoroscopy time (FT), that has already been demonstrated to be associated with outcomes and complexity of coronary procedures. The aim of our study is to demonstrate the relationship between FT and the short-term outcomes after TAVR defined by to the Valve Academic Research Consortium (VARC)-2 and -3 consensus documents. METHODS After splitting 1797 consecutive patients into tertiles of FT, the composite endpoint early safety (ES) was adjudicated according to VARC-2 and VARC-3 definitions, whereas the composite endpoints device success (DS) and technical success (TS) according to VARC-3 criteria. RESULTS The absence of all these outcomes (VARC-2 ES amd VARC-3 TS, DS, and ES) was significantly associated with longer FT: this association was independent from both intraprocedural complications and other intraprocedural factors linked to longer FT, and still persisted after propensity score matching analysis. Notwithstanding, after receiver operating characteristic analysis, FT had adequate diagnostic accuracy in identifying the absence of only VARC-3 TS and VARC-2 ES. CONCLUSION Longer FT is related with periprocedural and short-term outcomes after the procedure, especially in those that are more challenging. A FT duration of more than 30 min has an adequate accuracy in identifying VARC-3 technical failure (TS and DS) and absence of VARC-2 ES, selecting patients who are likely to take advantage from more careful in-hospital follow-up.
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Affiliation(s)
| | - Francesco Spione
- Interventional Cardiology Service, “Montevergine” Clinic, GVM Care & Research, 83013 Mercogliano, Italy; (F.S.); (T.T.)
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Osvaldo Burattini
- Division of Cardiology, “SS. Annunziata” Hospital, 74121 Taranto, Italy; (O.B.); (F.I.)
| | - Daniele De Feo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Alessandro Xhelo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Chiara Palmitessa
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Maurizio D’Alessandro
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Vincenzo Pio Amendola
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Flavio Rimmaudo
- Division of Cardiology, “Vittorio Emanuele” Hospital, 93012 Gela, Italy;
| | - Andrea Igoren Guaricci
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy;
| | | | - Gaetano Contegiacomo
- Interventional Cardiology Service, “Anthea” Clinic, GVM Care & Research, 70124 Bari, Italy;
| | - Tullio Tesorio
- Interventional Cardiology Service, “Montevergine” Clinic, GVM Care & Research, 83013 Mercogliano, Italy; (F.S.); (T.T.)
| | - Giuseppe Colonna
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy;
| | - Fortunato Iacovelli
- Division of Cardiology, “SS. Annunziata” Hospital, 74121 Taranto, Italy; (O.B.); (F.I.)
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
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Agricola E, Ancona F, Bartel T, Brochet E, Dweck M, Faletra F, Lancellotti P, Mahmoud-Elsayed H, Marsan NA, Maurovich-Hovart P, Monaghan M, Pontone G, Sade LE, Swaans M, Von Bardeleben RS, Wunderlich N, Zamorano JL, Popescu BA, Cosyns B, Donal E. Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: a consensus document of the EACVI Task Force on Interventional Cardiovascular Imaging: part 1: access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions. Eur Heart J Cardiovasc Imaging 2023; 24:e209-e268. [PMID: 37283275 DOI: 10.1093/ehjci/jead096] [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: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Transcatheter therapies for the treatment of structural heart diseases (SHD) have expanded dramatically over the last years, thanks to the developments and improvements of devices and imaging techniques, along with the increasing expertise of operators. Imaging, in particular echocardiography, is pivotal during patient selection, procedural monitoring, and follow-up. The imaging assessment of patients undergoing transcatheter interventions places demands on imagers that differ from those of the routine evaluation of patients with SHD, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of SHD therapies, this document intends to update the previous consensus document and address new advancements in interventional imaging for access routes and treatment of patients with aortic stenosis and regurgitation, and mitral stenosis and regurgitation.
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Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, Milan 20132, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - Thomas Bartel
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, 26th Street, Dubai, United Arab Emirates
| | - Eric Brochet
- Cardiology Department, Hopital Bichat, 46 rue Huchard, Paris 75018, France
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Francesco Faletra
- Senior SHD Consultant Istituto Cardiocentro Via Tesserete 48, CH-6900 Lugano, Switzerland
- Senior Imaging Consultant ISMETT UPCM Hospital, Discesa dei Giudici, 4, 90133 Palermo, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh-Heart & Vascular Institute UPMC, 200 Lothrop St Ste E354.2, Pıttsburgh, PA 15213, USA
- Cardiology Department, Baskent University, Ankara, Turkey
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Nina Wunderlich
- Asklepios Klinik Langen Röntgenstrasse 20, Langen 63225, Germany
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila' -Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Universite´ de Rennes-1, Rennes, France
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Vetrovec GW, Kaki A, Wollmuth J, Dahle TG. Strategies for Reducing Vascular and Bleeding Risk for Percutaneous Left Ventricular Assist Device-supported High-risk Percutaneous Coronary Intervention. Heart Int 2022; 16:105-111. [PMID: 36741103 PMCID: PMC9872781 DOI: 10.17925/hi.2022.16.2.105] [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: 11/24/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
In patients at high risk for haemodynamic instability during percutaneous coronary intervention (PCI), practitioners are increasingly opting for prophylactic mechanical circulatory support, such as the Impella® heart pump (Abiomed, Danvers, MA, USA). Though Impella-supported high-risk PCI (HRPCI) ensures haemodynamic stability during the PCI procedure, access-related complication rates have varied significantly in published studies. Reported variability in complication rates relates to many factors, including anticoagulation practices, access and closure strategy, post-procedure care and variations in event definitions. This article aims to outline optimal strategies to minimize vascular and bleeding complications during Impella-supported HRPCI based on previously identified clinical, procedural and postprocedural risk factors. Practices to reduce complications include femoral skills training, standardized protocols to optimize access, closure, anticoagulation management and post-procedural care, as well as the application of techniques and technological advances. Protocols integrating these strategies to mitigate access-related bleeding and vascular complications for Impella-supported procedures can markedly limit vascular access risk as a barrier to appropriate large-bore mechanical circulatory support use in HRPCI.
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Affiliation(s)
- George W Vetrovec
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amir Kaki
- Division of Cardiology, St. John’s Hospital, Wayne State University, Detroit, MI, USA
| | - Jason Wollmuth
- Providence Heart and Vascular Institute, Providence, OR, USA
| | - Thom G Dahle
- CentraCare Heart & Vascular Center, St. Cloud Hospital, St. Cloud, MN, USA
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Abusnina W, Machanahalli Balakrishna A, Ismayl M, Latif A, Reda Mostafa M, Al-Abdouh A, Junaid Ahsan M, Radaideh Q, Haddad TM, Goldsweig AM, Ben-Dor I, Mamas MA, Dahal K. Comparison of Transfemoral versus Transsubclavian/Transaxillary access for transcatheter aortic valve replacement: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2022; 43:101156. [PMID: 36471671 PMCID: PMC9718962 DOI: 10.1016/j.ijcha.2022.101156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Safe alternative access, that represents about 15 % of TAVR cases, remains important for patients without adequate transfemoral access. We aimed to perform a systematic review and meta-analysis of studies comparing transfemoral (TF) access versus transsubclavian or transaxillary (TSc/TAx) access in patients undergoing TAVR. We searched PubMed, Cochrane CENTRAL Register, EMBASE, Web of Science, Google Scholar and ClinicalTrials.gov (inception through May 24, 2022) for studies comparing (TF) to (TSc/TAx) access for TAVR. A total of 21 studies with 75,995 unique patients who underwent TAVR (73,203 transfemoral and 2,792 TSc/TAx) were included in the analysis. There was no difference in the risk of in-hospital and 30-day all-cause mortality between the two groups (RR 0.64, 95 % CI 0.36-1.13, P = 0.12) and (RR 0.95, 95 % CI 0.64-1.41, P = 0.81), while 1-year mortality was significantly lower in the TF TAVR group (RR 0.79, 95 % CI 0.67-0.93, P = 0.005). No significant differences in major bleeding (RR 0.82, 95 % CI 0.65-1.03, P = 0.09), major vascular complications (RR 1.14, 95 % CI 0.75-1.72, P = 0.53), and stroke (RR 0.66, 95 % CI 0.42-1.02, P = 0.06) were observed. In patients undergoing TAVR, TF access is associated with significantly lower 1-year mortality compared to TSc/TAx access without differences in major bleeding, major vascular complications and stroke. While TF is the preferred approach for TAVR, TSc/TAx is a safe alternative approach. Future studies should confirm these findings, preferably in a randomized setting.
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Key Words
- AKI, Acute Kidney Injury
- AS, Aortic Stenosis
- Access site
- Axillary access
- CI, Confidence Interval
- Femoral access
- MI, Myocardial Infarction
- RR, Risk Ratio
- Subclavian access
- TAVI
- TAVR
- TAVR, Transcatheter Aortic Valve Replacement
- TAx, Transaxillary
- TC, Transcarotid
- TF, Transfemoral
- TSc, Transsubclavian
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Affiliation(s)
- Waiel Abusnina
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | | | - Mahmoud Ismayl
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Azka Latif
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | | | - Ahmad Al-Abdouh
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Qais Radaideh
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Toufik M Haddad
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, UK
| | - Khagendra Dahal
- Division of Cardiology, Creighton University School of Medicine, NE, USA
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Mitsis A, Eftychiou C, Christophides T, Sakellaropoulos S, Avraamides P. The conjunction conundrum in Transcatheter Aortic Valve Implantation. Curr Probl Cardiol 2022; 48:101130. [PMID: 35114293 DOI: 10.1016/j.cpcardiol.2022.101130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
A continuous discussion regarding the predictors for permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) is ongoing, especially in the era of low and medium risk patients. The aim of this article is to review the data so far regarding the pathophysiology, risk factors, and the indications for permanent pacemaker implantation after TAVI. The factors that contribute to rhythm abnormalities post TAVI can be divided into pre-existing conduction abnormalities, patient-related anatomical factors, and peri-procedural technical factors. The latter components are potentially modifiable, and this is where attention should be directed, particularly now that in an era of TAVI expansion towards lower-risk patients.
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Key Words
- AF, Atrial fibrillation
- AS, Aortic stenosis
- AV, Atrioventricular
- BAV, Balloon aortic valvuloplasty
- BBB, Bundle branch block
- BEV, Balloon expandable valve
- CAVB, Complete Atrioventricular block
- CRT,
- CT, Computer tomography
- Cardiac resynchronization therapy
- ECG, Electrocardiogram
- EPS, Electrophysiology study
- ID, Implantation depth
- LAH, Left anterior hemiblock
- LBBB, Left bundle branch block
- LCC, Left coronary cusp
- LVEF, Left ventricular ejection function
- LVOT, Left ventricular outflow track
- LVOT- EI, Left ventricular outflow track eccentricity index
- LVOT-CA, Left ventricular outflow track calcification
- MS, Membranous septum
- NCC, Non coronary cusp
- PPI, Permanent pacemaker implantation
- PVL, Paravalvular leak
- RAO, Right anterior oblique
- RBBB, Right bundle branch block
- RCC, Right coronary cusp
- SAS, Severe aortic stenosis
- SEV, Self-expandable valve
- TAVI, Transcatheter aortic valve implantation
- Transcatheter aortic valve implantation, pacemaker implantation, LBBB, balloon expandable valves, self-expandable valves, LVOT. List of abbreviations, AMCC, Aortomitral continuity calcification
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Affiliation(s)
- Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, 2029, Nicosia, Cyprus.
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9
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Pontone G, Marano R, Agricola E, Alushi B, Bartorelli A, Cameli M, Carrabba N, Esposito A, Faletti R, Francone M, Galea N, Golino P, Guglielmo M, Palmisano A, Petronio S, Petullà M, Pradella S, Ribichini F, Romeo F, Russo V, Scandura S, Schicchi N, Spaccarotella C, Tomai F, Centonze M, indolfi C. Recommendations in pre-procedural imaging assessment for transcatheter aortic valve implantation intervention. J Cardiovasc Med (Hagerstown) 2022; 23:216-227. [DOI: 10.2459/jcm.0000000000001293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Ranka S, Lahan S, Chhatriwalla AK, Allen KB, Chiang M, O'Neill B, Verma S, Wang DD, Lee J, Frisoli T, Eng M, Bagur R, O'Neill W, Villablanca P. Network meta-analysis comparing the short and long-term outcomes of alternative access for transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:1-10. [PMID: 34972667 DOI: 10.1016/j.carrev.2021.11.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have pair-wise compared access sites for transcatheter aortic valve replacement (TAVR) but pooled estimate of overall comparative efficacy and safety outcomes are not well known. We sought to compare short- and long-term outcomes following various alternative access routes for TAVR. METHODS Thirty-four studies with a pooled sample size of 32,756 patients were selected by searching PubMed and Cochrane library databases from inception through 11th June 2021 for patients undergoing TAVR via 1 of 6 different access sites: Transfemoral (TF), Transaortic (TAO), Transapical (TA), Transcarotid (TC), Transaxillary/Subclavian (TSA), and Transcaval (TCV). Data were extracted to conduct a frequentist network meta-analysis with a random-effects model using TF access as a reference group. RESULTS Compared with TF, both TAO [RR 1.91, 95% CI (1.46-2.50)] and TA access [RR 2.12, 95% CI (1.84-2.46)] were associated with an increased risk of 30-day mortality. No significant difference was observed for stroke, myocardial infarction, major bleeding, conversion to open surgery, and major adverse cardiovascular or cerebrovascular events at 30 days between different accesses. Major vascular complications were lower in TA [RR 0.43, (95% CI, 0.28-0.67)] and TC [RR 0.51, 95% CI (0.35-0.73)] access compared to TF. The 1-year mortality was higher in TAO [RR of 1.35, (95% CI, 1.01-1.81)] and TA [RR 1.44, (95% CI, 1.14-1.81)] groups. CONCLUSION Non-thoracic alternative access site utilization for TAVR implantation (TC, TSA and TCV) is associated with outcomes similar to conventional TF access. Thoracic TAVR access (TAO and TA) translates into increased short and long-term mortality.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shubham Lahan
- Division of Cardiovascular Prevention & Wellness, Department of Cardiology, Houston Methodist, Houston, TX, United States
| | - Adnan K Chhatriwalla
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Michael Chiang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Brian O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Sadhika Verma
- Department of Family Medicine, Henry Ford Allegiance Health, Jackson, MI, United States
| | - Dee Dee Wang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - James Lee
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Tiberio Frisoli
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Marvin Eng
- Department of Cardiology, Banner University Medical Center, Phoenix, AZ, United States
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - William O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Pedro Villablanca
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States.
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Pighi M, Giovannini D, Scarsini R, Piazza N. Diagnostic Work-Up of the Aortic Patient: An Integrated Approach toward the Best Therapeutic Option. J Clin Med 2021; 10:5120. [PMID: 34768640 PMCID: PMC8584438 DOI: 10.3390/jcm10215120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 01/09/2023] Open
Abstract
Aortic stenosis (AS) is the most common valvular heart disease. In the last decade, transcatheter aortic valve implantation (TAVI) has become the standard of care for symptomatic patients at high surgical risk. Recently, indications to TAVI have also been extended to the low surgical risk and intermediate surgical risk populations. Consequently, in this setting, some aspects acquire greater relevance: surgical risk evaluation, clinical assessment, multimodality imaging of the valve, and management of coronary artery disease. Moreover, future issues such as coronary artery re-access and valve-in-valve interventions should be considered in the valve selection process. This review aims to summarize the principal aspects of a multidimensional (multidisciplinary) and comprehensive preprocedural work-up. The Heart Team is at the center of the decision-making process of the management of aortic valve disease and bears responsibility for offering each patient a tailored approach based on an individual evaluation of technical aspects together with the risks and benefits of each modality. Considering the progressive expansion in TAVI indication and technological progress, the role of a work-up and multidisciplinary Heart Team will be even more relevant.
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Affiliation(s)
- Michele Pighi
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada;
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (R.S.)
| | - Davide Giovannini
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (R.S.)
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (R.S.)
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada;
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12
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Alternative Access for Transcatheter Aortic Valve Replacement: A Comprehensive Review. Interv Cardiol Clin 2021; 10:505-517. [PMID: 34593113 DOI: 10.1016/j.iccl.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Transfemoral is the most widely used access to perform transcatheter aortic valve replacement (TAVR). However, alternative access is needed in up to 21% of patients with TAVR because of a myriad of factors. The authors provide a comprehensive review on alternative access for TAVR, discussing the relevant data and providing the pros and cons of each access route.
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Andersen HR. How Transcatheter Aortic Valve Implantation (TAVI) Was Born: The Struggle for a New Invention. Front Cardiovasc Med 2021; 8:722693. [PMID: 34660724 PMCID: PMC8511628 DOI: 10.3389/fcvm.2021.722693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 01/07/2023] Open
Abstract
This story is about the invention of transcatheter aortic valve implantation (TAVI), and the people who transformed it from a concept and primitive device to a breakthrough lifesaving treatment for hundreds of thousands of patients with aortic valve stenosis. It is an inspirational example of a new disruptive technology that began with an idea most dismissed. The story describes the ups and downs from idea, design, construction, animal testing, proof-of-concept, scientific publication hurdles, a patent, license agreement, cooperation with several companies, fighting in patent courts in Europe and USA and finally how multinational companies financially bypassed the inventor. It is also a story about the struggles and battles the inventor experienced when injected into a world of lawyers and patent fights. I hope my personal story and journey can provide an inspiration and word of caution for new inventors.
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Affiliation(s)
- Henning Rud Andersen
- Department of Cardiology, Research Unit, Aarhus University Hospital, Aarhus, Denmark
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14
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Ullah W, Zahid S, Zaidi SR, Sarvepalli D, Haq S, Roomi S, Mukhtar M, Khan MA, Gowda SN, Ruggiero N, Vishnevsky A, Fischman DL. Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement - A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e020906. [PMID: 34259045 PMCID: PMC8483489 DOI: 10.1161/jaha.121.020906] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background As transcatheter aortic valve replacement (TAVR) technology expands to healthy and lower‐risk populations, the burden and predictors of procedure‐related complications including the need for permanent pacemaker (PPM) implantation needs to be identified. Methods and Results Digital databases were systematically searched to identify studies reporting the incidence of PPM implantation after TAVR. A random‐ and fixed‐effects model was used to calculate unadjusted odds ratios (OR) for all predictors. A total of 78 studies, recruiting 31 261 patients were included in the final analysis. Overall, 6212 patients required a PPM, with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%. The pooled estimates on a random‐effects model indicated significantly higher odds of post‐TAVR PPM implantation for men (OR, 1.16; 95% CI, 1.04–1.28); for patients with baseline mobitz type‐1 second‐degree atrioventricular block (OR, 3.13; 95% CI, 1.64–5.93), left anterior hemiblock (OR, 1.43; 95% CI, 1.09–1.86), bifascicular block (OR, 2.59; 95% CI, 1.52–4.42), right bundle‐branch block (OR, 2.48; 95% CI, 2.17–2.83), and for periprocedural atriorventricular block (OR, 4.17; 95% CI, 2.69–6.46). The mechanically expandable valves had 1.44 (95% CI, 1.18–1.76), while self‐expandable valves had 1.93 (95% CI, 1.42–2.63) fold higher odds of PPM requirement compared with self‐expandable and balloon‐expandable valves, respectively. Conclusions Male sex, baseline atrioventricular conduction delays, intraprocedural atrioventricular block, and use of mechanically expandable and self‐expanding prosthesis served as positive predictors of PPM implantation in patients undergoing TAVR.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospitals Philadelphia PA
| | | | | | | | | | | | - Maryam Mukhtar
- University Hospitals of Leicester NHS Trust Leicester UK
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15
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Tagliari AP, Saadi RP, Ferrari E, Taramasso M, Saadi EK. The Role of the Axillary Artery as a Second Access Choice in TAVI Procedures. Braz J Cardiovasc Surg 2021; 36:237-243. [PMID: 33355810 PMCID: PMC8163263 DOI: 10.21470/1678-9741-2020-0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
With transcatheter aortic valve implantation (TAVI) technology expanding its indications for low-risk patients, the number of TAVI-eligible patients will globally grow, requiring a better understanding about the second-best access choice. Regarding the potential access sites, the transfemoral retrograde route is recognized as the standard approach and first choice according to current guidelines. However, this approach is not suitable in up to 10-15% of patients, for whom an alternative non-femoral access is required. Among the alternative non-femoral routes, the transaxillary approach has received increasing recognition due to its proximity and relatively straight course from the axillary artery to the aortic annulus, which provides a more accurate device deployment. Here we discuss some particular aspects of the transaxillary access, either percutaneously performed or by cutdown dissection.
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Affiliation(s)
- Ana Paula Tagliari
- Department of Cardiac Surgery, University Hospital of Zurich, University Heart Center Zurich, Zurich, Switzerland.,Department of Cardiovascular Surgery, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.,Postgraduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo Petersen Saadi
- Postgraduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Department of Cardiovascular Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Enrico Ferrari
- Department of Cardiac Surgery, University Hospital of Zurich, University Heart Center Zurich, Zurich, Switzerland.,Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Maurizio Taramasso
- Department of Cardiac Surgery, University Hospital of Zurich, University Heart Center Zurich, Zurich, Switzerland
| | - Eduardo Keller Saadi
- Department of Cardiovascular Surgery, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.,Department of Cardiovascular Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
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16
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Mangieri A, Laricchia A, Montalto C, Palena ML, Fisicaro A, Cereda A, Sticchi A, Latib A, Giannini F, Khokhar AA, Colombo A. Patient selection, procedural planning and interventional guidance for transcatheter aortic valve intervention. Minerva Cardiol Angiol 2021; 69:671-683. [PMID: 33703862 DOI: 10.23736/s2724-5683.21.05573-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis across a broad spectrum of patient risk profiles. Pre-procedural planning using multislice computed tomography (MSCT) is a fundamental component to ensure acute and long-term procedural success. MSCT can establish the procedural feasibility, the type vascular of approach as well as the device which is more likely to give a good result. Moreover, MSCT is a key tool to estimate the risk of potentially life-threatening complications. In this review, the role of MSCT for pre-procedural TAVR planning will be discussed providing a panoramic overview of the key elements that should be considered when performing TAVR. Additionally, the adjunctive role of fluoroscopy and echocardiography to plan and guide a TAVR procedure will also be discussed.
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Affiliation(s)
- Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy -
| | - Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariano L Palena
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Andrea Fisicaro
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alberto Cereda
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alessandro Sticchi
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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17
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Utility of the minimum-incision transsubclavian approach for transcatheter aortic valve replacement on clinical outcomes in patients with small vessel anatomy. J Cardiol 2021; 78:31-36. [PMID: 33637407 DOI: 10.1016/j.jjcc.2021.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/06/2020] [Accepted: 12/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The optimal approach for patients undergoing transcatheter aortic valve replacement (TAVR), who are contraindicated for a transfemoral (TF) approach, is still controversial. The present study aimed to evaluate the utility of the TAVR via a subclavian artery with a small diameter, by minimal incision and a double Z suture hemostasis technique using 18 Fr DrySeal Flex sheath, namely minimum-incision transsubclavian TAVR (MITS-TAVR), in patients contraindicated for the TF approach. METHODS We included consecutive patients who underwent the MITS-TAVR (MITS group; n = 21) and TF-TAVR (TF group; n = 81) using the CoreValve Evolut R/PRO valves and examined the incidence of in-hospital adverse events and post-discharge mortality between the two groups. RESULTS The mean body surface area was significantly smaller in the MITS group (1.33 ± 0.04 vs. 1.43 ± 0.02 m2; p = 0.045). The minimal lumen diameter of the femoral artery was significantly smaller in the MITS group (5.01 vs. 6.43 mm; p < 0.01). The lumen diameter of the left subclavian artery (LSA) in the MITS group was 4.97 ± 0.14 mm. The duration of the TAVR procedure to discharge was not significantly different (9.7 ± 2.0 days vs. 13.2 ± 1.0 days; p = 0.239). We did not experience in-hospital death in both groups, and no significant differences were observed in the incidence of major adverse cardiac and cerebrovascular events between the two groups. The post-discharge survival rate was not significantly different between the groups (at 2-year; MITS group vs. TF group = 91.0% vs. 89.0%; p = 0.725). CONCLUSIONS The MITS-TAVR using 18 Fr Dryseal Flex sheath was safe and effective and might be a promising alternative approach even in patients with a small body and small LSA diameter, who are contraindicated to the TF approach.
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Abstract
Femoral arterial access is the default strategy for large-bore interventional procedures, including temporary mechanical circulatory support implantation and structural heart therapies, based on superior outcomes and operator ease. In addition to patient size and comorbidities, vessel tortuosity, significant calcification, and diminutive vessel caliber all may make iliofemoral access prohibitively high risk or impossible. Given the increase of large-bore transcatheter procedures, bleeding avoidance strategies are essential and thus novel mechanisms for large-bore access have evolved. This article highlights the advantages, limitations, and practical approaches to the 2 most common percutaneous large-bore alternative access strategies: transaxillary and transcaval access.
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Affiliation(s)
- Amy E Cheney
- Department of Internal Medicine, Division of Cardiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195-6171, USA
| | - James M McCabe
- Department of Internal Medicine, Division of Cardiology, University of Washington Medical Center, 1959 Northeast Pacific Street, Seattle, WA 98195-6171, USA.
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Zhang Y, Pan WZ, Guan LH, Zhang XC, Chen SS, Yang LF, Zhang L, Li MF, Chen DD, Zhou DX, Ge JB. Small balloon strategy associated with low pacemaker implantation rate after self-expanding transcatheter valve implantation. World J Emerg Med 2021; 12:48-53. [PMID: 33505550 DOI: 10.5847/wjem.j.1920-8642.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This study aims to investigate whether small balloon aortic valvuloplasty (BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valve implantation (TAVI). METHODS This was a retrospective analysis using data from our local TAVI database. Small BAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as a balloon size >18 mm. The primary endpoint was the incidence of new PPMI. RESULTS Of 99 consecutive TAVI patients, five patients were excluded due to pre-existing permanent pacemaker. Patients in the small BAV group (n=57) had a significantly lower PPMI rate compared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aortic valve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3% vs. 8.1%, P=0.480); likewise, the mean aortic gradient post-procedure did not differ significantly (11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Device success rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV (P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradient by echo in the basement (P=0.021) were independent predictors of PPMI. CONCLUSIONS The small BAV strategy is associated with a low rate of permanent pacemaker implantation after transcatheter self-expanding valve implantation in this single-center observational study.
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Affiliation(s)
- Yuan Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wen-Zhi Pan
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Li-Hua Guan
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiao-Chun Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Sha-Sha Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Li-Fan Yang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ming-Fei Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dan-Dan Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Da-Xin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jun-Bo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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20
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Trani C, Aurigemma C, Romagnoli E, Burzotta F. Percu-Ax aortic valve implantation with a double arm approach: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33204992 PMCID: PMC7649516 DOI: 10.1093/ehjcr/ytaa225] [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: 12/27/2019] [Revised: 02/03/2020] [Accepted: 06/24/2020] [Indexed: 12/05/2022]
Abstract
Background Transaxillary route for structural and coronary percutaneous interventions represents a valid alternative access in patients with obstructive peripheral disease. Nevertheless, its widespread use is limited by a less manageable haemostasis procedure. Case summary In this case, we describe a minimalistic high-risk transcatheter aortic valve implantation (TAVI) procedure (TAVI Score 6.42%) conducted with a double arm approach (radial and axillary accesses) in an 88-year-old patient with severe aortic stenosis and multiple co-morbidities preventing both surgical (Society of Thoracic Surgeons mortality 7.9%) and percutaneous transfemoral approach (extensive peripheral artery disease). We also described the successful management of a complicated transaxillary haemostasis with this technique. Discussion In our cases, a minimalist double-arm approach was successfully used for TAVI procedure as an alternative to transfemoral approach assuring effective and safe management of vascular access haemostasis.
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Affiliation(s)
- Carlo Trani
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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21
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Faroux L, Junquera L, Mohammadi S, Del Val D, Muntané-Carol G, Alperi A, Kalavrouziotis D, Dumont E, Paradis JM, Delarochellière R, Rodés-Cabau J. Femoral Versus Nonfemoral Subclavian/Carotid Arterial Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e017460. [PMID: 32990146 PMCID: PMC7792420 DOI: 10.1161/jaha.120.017460] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Some concerns remain regarding the safety of transcarotid and transsubclavian approaches for transcatheter aortic valve replacement. We aimed to compare the risk of 30‐day complications and death in transcarotid/transsubclavian versus transfemoral transcatheter aortic valve replacement recipients. Methods and Results Data from 20 studies, including 79 426 patients (16 studies) and 3992 patients (4 studies) for the evaluation of the unadjusted and adjusted impact of the arterial approach were sourced, respectively. The use of a transcarotid/transsubclavian approach was associated with an increased risk of stroke when using unadjusted data (risk ratio [RR], 2.28; 95% CI, 1.90–2.72) as well as adjusted data (odds ratio [OR], 1.53; 95% CI, 1.05–2.22). The pooled results deriving from unadjusted data showed an increased risk of 30‐day death (RR, 1.46; 95% CI, 1.22–1.74) and bleeding (RR, 1.53; 95% CI, 1.18–1.97) in patients receiving transcatheter aortic valve replacement through a transcarotid/transsubclavian access (compared with the transfemoral group), but the associations between the arterial access and death (OR, 1.22; 95% CI, 0.89–1.69), bleeding (OR, 1.05; 95% CI, 0.68–1.61) were no longer significant when using adjusted data. No significant effect of the arterial access on vascular complication was observed in unadjusted (RR, 0.84; 95% CI, 0.66–1.06) and adjusted (OR, 0.79; 95% CI, 0.53–1.17) analyses. Conclusions Transcarotid and transsubclavian approaches for transcatheter aortic valve replacement were associated with an increased risk of stroke compared with the transfemoral approach. However, these nonfemoral arterial alternative accesses were not associated with an increased risk of 30‐day death, bleeding, or vascular complication when taking into account the confounding factors.
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Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - Lucia Junquera
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - David Del Val
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | - Alberto Alperi
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | - Eric Dumont
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
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22
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Southmayd G, Hoque A, Kaki A, Tayal R, Rab ST. Percutaneous
large‐bore
axillary access is a safe alternative to surgical approach: A systematic review. Catheter Cardiovasc Interv 2020; 96:1481-1488. [DOI: 10.1002/ccd.29273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/30/2020] [Accepted: 09/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Geoffrey Southmayd
- Division of Cardiology Emory University School of Medicine Atlanta Georgia
| | - Azizul Hoque
- Division of Cardiology Emory University School of Medicine Atlanta Georgia
| | - Amir Kaki
- Division of Cardiology Ascension St. John Hospital Detroit Michigan
| | - Rajiv Tayal
- Division of Cardiology RWJ Barnabas Health, Newark Beth Israel Medical Center Newark New Jersey
| | - S. Tanveer Rab
- Division of Cardiology Emory University School of Medicine Atlanta Georgia
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23
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Kaneko U, Hachinohe D, Kobayashi K, Shitan H, Mitsube K, Furugen A, Kawamura T, Koshima R, Fujita T. Evolut Self-Expanding Transcatheter Aortic Valve Replacement in Patients with Extremely Horizontal Aorta (Aortic Root Angle ≥ 70°). Int Heart J 2020; 61:1059-1069. [PMID: 32921666 DOI: 10.1536/ihj.20-120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Because of its rigidity and non-steerability, the presence of a horizontal aortic root poses a major anatomical issue during transcatheter aortic valve replacement (TAVR) with Evolut self-expanding valve. Previous studies have elucidated the difficulties of coaxial implantation of the self-expanding valve in patients with horizontal aorta, often resulting in increased complications and a lower device success rate. To date, most patients with extremely horizontal aorta (aortic root angle ≥ 70°) have been excluded from major TAVR clinical trials. Therefore, available data on TAVR with Evolut in this challenging anatomy are limited, and standardized treatment strategies and clinical results remain unknown. Herein, we report a clinical case series of TAVR with Evolut in extremely horizontal aorta. Among seven patients (aged 80-92 years; STS score, 12.6% ± 7.9%) who underwent TAVR with Evolut system, aortic root angle ranged from 71° to 83° (mean, 75.1°± 4.5°). All patients achieved device success with dedicated strategies and were clinically stable at 3-month follow-up. None of the patients had more than mild paravalvular leakage (PVL) at any point during follow-up.Complications in three patients included complete atrioventricular block requiring a permanent pacemaker implantation, cerebral infarction because of atrial fibrillation 3 days after TAVR, and cardiac tamponade requiring pericardiocentesis. In this case series, Evolut self-expanding TAVR in extremely horizontal aorta was effective and feasible with a high device success rate. Based on anatomical features, some dedicated strategies majorly contribute to the success of this procedure. Large-scale multicenter studies are required to confirm our findings.
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Affiliation(s)
- Umihiko Kaneko
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Daisuke Hachinohe
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Ken Kobayashi
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Hidemasa Shitan
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Keijiro Mitsube
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Azusa Furugen
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Takeshi Kawamura
- Department of Anesthesiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Ryuji Koshima
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
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24
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Colegrave N, Mascitti P, Zannis K, Miceli P, Veugeois A, Caussin C, Philip I. Ultrasound-Guided Intermediate Cervical Plexus Block for Transcarotid Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2020; 35:1747-1750. [PMID: 32948407 DOI: 10.1053/j.jvca.2020.08.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To report the authors' initial experience of transcarotid transcatheter aortic valve replacement (TAVR) managed with ultrasound-guided intermediate cervical plexus block. DESIGN A single-center prospective study. SETTING A teaching hospital in Paris, France. PARTICIPANTS All consecutive patients undergoing a transcarotid TAVR were included. INTERVENTIONS The ultrasound-guided intermediate cervical plexus block was performed in 28 of 31 patients. In 3 patients, the procedure was scheduled under general anesthesia: 2 because of failure of previous transfemoral procedures under local anesthesia, and 1 for an emergency procedure in a pulmonary edema context. MEASUREMENTS AND MAIN RESULTS Anesthesia and all perioperative parameters were recorded, as well as any complications after the procedure. Twenty-eight patients were managed with intermediate cervical plexus block and light sedation without any anesthesia-related complication. No conversion to general anesthesia was required. The use of vasopressor was only required in 11% of the patients. In 2 patients, a loss of consciousness after the common carotid artery cross-clamping test occurred, leading to the use of a temporary femoral-carotid shunt; no other change in consciousness was recorded during the procedure. CONCLUSIONS Ultrasound-guided intermediate cervical plexus block appeared to be an alternative anesthetic technique for carotid TAVR, providing adequate surgical conditions, continuous neurologic monitoring, and arterial pressure stability.
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Affiliation(s)
- Nora Colegrave
- Department of Anesthesiology, Institut Mutualiste Montsouris, Paris, France
| | - Paola Mascitti
- Department of Anesthesiology, Institut Mutualiste Montsouris, Paris, France
| | - Konstandinos Zannis
- Department of Cardiology and Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France
| | - PierLuigi Miceli
- Department of Anesthesiology, Institut Mutualiste Montsouris, Paris, France
| | - Aurélie Veugeois
- Department of Cardiology and Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Christophe Caussin
- Department of Cardiology and Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Ivan Philip
- Department of Anesthesiology, Institut Mutualiste Montsouris, Paris, France.
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25
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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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26
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Grant JK, Maniam A, Celli D, Orozco-Sevilla V, Braghiroli J. Large-bore arterial access in the era of structural cardiovascular disease. J Card Surg 2020; 35:3088-3098. [PMID: 32741006 DOI: 10.1111/jocs.14909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022]
Abstract
Over the last two decades, the medical community witnessed an outstanding and accelerated development on minimally invasive therapies. The definition of what constitutes large bore access is subject to discussion, however within the field it is generally accepted to reflect a catheter diameter exceeding 8-French. We sought in this review to explore the evolution, characteristics and vascular compatibility of the current commercially available devices, analyze the devices along with access site-specific complications rates and finally review the present methods for percutaneous vascular closure.
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Affiliation(s)
- Jelani K Grant
- Department of Medicine, Jackson Memorial Hospital, University of Miami, Coral Gables, Florida
| | - Akash Maniam
- Department of Medicine and Oncology, Sangre Grande County Hospital, Sangre Grande, Trinidad and Tobago
| | - Diego Celli
- Department of Medicine, Jackson Memorial Hospital, University of Miami, Coral Gables, Florida
| | - Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joao Braghiroli
- Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami, Coral Gables, Florida
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27
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Bob-Manuel T, Almusawi H, Rezan T, Khaira H, Akingbola A, Nasir A, Soto JT, Jenkins J, Ibebuogu UN. Efficacy and Safety of Transcarotid Transcatheter Aortic Valve Replacement: A Systematic Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:917-926. [DOI: 10.1016/j.carrev.2019.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/17/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022]
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28
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Kuo F, Park J, Chow K, Chen A, Walsworth MK. Avoiding peripheral nerve injury in arterial interventions. ACTA ACUST UNITED AC 2020; 25:380-391. [PMID: 31310240 DOI: 10.5152/dir.2019.18296] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although peripheral nerve injuries secondary to angiography and endovascular interventions are uncommon and usually not permanent, they can result in significant functional impairment. Most arteries used in access for angiography and endovascular therapies lie in close proximity to a nerve. The nerve may be injured by needle puncture, or by compression from hematoma, pseudoaneurysm, hemostasis devices, or by manual compression with incidence in literature ranging from as low as 0.04% for femoral access in a large retrospective study to 9% for brachial and axillary access. Given the increasing frequency of endovascular arterial procedures and the increasing use of nontraditional access points, it is important that the interventionalist have a working knowledge of peripheral nerve anatomy and function as it relates to relevant arterial access sites to avoid injury.
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Affiliation(s)
- Frank Kuo
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Park
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kira Chow
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Alice Chen
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Matthew K Walsworth
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
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29
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Romano M, Daprati A, Saitto G, Tizzano F, Le Houérou D, Donzeau-Gouge P, Farge A, Lefèvre T, Hovasse T, Garatti A. Safety and effectiveness of a transaortic approach for TAVI: procedural and midterm outcomes of 265 consecutive patients in a single centre. Interact Cardiovasc Thorac Surg 2019; 30:400-407. [DOI: 10.1093/icvts/ivz269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/17/2019] [Accepted: 10/20/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
Transcatheter aortic valve implantation with a transaortic approach (TAo-TAVI) is an alternative to transapical or femoral access. We studied the procedural and midterm efficacy and safety of TAo-TAVI with Edwards Sapien XT and Medtronic CoreValve devices.
METHODS
Among 901 patients receiving TAVI since 2006, 265 consecutive patients underwent TAo-TAVI between January 2011 and September 2014. Procedural and midterm results were evaluated according to Valve Academic Research Consortium-2 criteria.
RESULTS
The mean age was 83 ± 5 years. Sapien XT and CoreValve were used in 191 (72.1%) and 74 (27.9%) patients, respectively. Full sternotomy made elective concomitant off-pump coronary artery bypass grafting possible in 38 patients (14.3%) with severe coronary artery disease unsuitable for percutaneous coronary intervention. The device success rate was 95.5%. Postprocedural paravalvular leak ≥2/4 was observed in 16 patients (6.4%). Emergency open chest surgery was required in 10 patients (3.8%) (3 aortic dissections, 3 valve embolizations, 2 LMCA occlusions, 1 aortic annulus rupture and 1 aortic rupture). Cerebrovascular accidents occurred in 3 patients (1.1%). Transfusions ≥4 units were required in 36 patients (13.6%). New pacemakers were implanted in 26 patients (9.8%). Thirty-day and 1-year mortality were 8.7% and 16.2%, respectively. Mean follow-up duration was 24 ± 6 months. At 3 years, freedom from all-cause death was 80% ± 4%. New York Heart Association class <III included 81% (n = 172) of patients alive and without prosthetic echocardiographic dysfunction at follow-up (mean gradient 10.5 ± 5.6 mmHg).
CONCLUSION
The TAo-TAVI approach confirms its safety and effectiveness with satisfactory procedural and midterm outcomes with both currently available devices.
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Affiliation(s)
- Mauro Romano
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Andrea Daprati
- Department of Cardiac Surgery, Policlinico S. Donato Hospital, S. Donato Milanese, Milan, Italy
| | - Guglielmo Saitto
- Department of Cardiac Surgery, Policlinico S. Donato Hospital, S. Donato Milanese, Milan, Italy
| | - Francesco Tizzano
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Daniel Le Houérou
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Patrick Donzeau-Gouge
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Arnaud Farge
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Thierry Lefèvre
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Thomas Hovasse
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Andrea Garatti
- Department of Cardiac Surgery, Policlinico S. Donato Hospital, S. Donato Milanese, Milan, Italy
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30
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Ng VG, Hahn RT, Nazif TM. Planning for Success: Pre-procedural Evaluation for Transcatheter Aortic Valve Replacement. Cardiol Clin 2019; 38:103-113. [PMID: 31753169 DOI: 10.1016/j.ccl.2019.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Vivian G Ng
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA
| | - Tamim M Nazif
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY 10032, USA.
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31
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Abstract
Initially, transcatheter aortic valve replacement (TAVR) was only used in patients with severe symptomatic aortic stenosis and prohibitive risk for surgical aortic valve replacement. Subsequently, TAVR was extended to patients with high and intermediate surgical risk. Recently, the results of randomized trials in low-surgical-risk patients showed superiority or noninferiority of TAVR versus surgical aortic valve replacement in this population. Procedural outcomes have been improved. Long-term durability of transcatheter heart valves remains to be confirmed. This article presents the evolution and current status of TAVR, with respect to the different types of devices and procedures as well as its outcomes.
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32
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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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33
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Russo E, Potenza DR, Casella M, Massaro R, Russo G, Braccio M, Dello Russo A, Cassese M. Rate and Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation: Current Status. Curr Cardiol Rev 2019; 15:205-218. [PMID: 30516109 PMCID: PMC6719385 DOI: 10.2174/1573403x15666181205105821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 11/22/2022] Open
Abstract
Transcather aortic valve implantation (TAVI) has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis who are at high surgical risk. Recently, outcomes after TAVI have improved significantly and TAVI has emerged as a qualified alternative to surgical aortic valve replacement in the treatment of intermediate risk patients and greater adoption of this procedure is to be expected in a wider patients population, including younger patients and low surgical risk patients. However since the aortic valve has close spatial proximity to the conduction system, conduction anomalies are frequently observed in TAVI. In this article, we aim to review the key aspects of pathophysiology, current incidence, predictors and clinical association of conduction anomalies following TAVI.
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Affiliation(s)
- Eleonora Russo
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy.,Department of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Domenico R Potenza
- Department of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Raimondo Massaro
- Department of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Giulio Russo
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Braccio
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Antonio Dello Russo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Cassese
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
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35
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Comparison of early and midterm outcomes after transsubclavian/axillary versus transfemoral, transapical, or transaortic transcatheter aortic valve implantation. Heart Lung 2019; 48:519-529. [PMID: 31076179 DOI: 10.1016/j.hrtlng.2019.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/30/2019] [Accepted: 04/05/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Outcomes after transsubclavian/transaxillary (TSc/TAx)-transcatheter aortic valve implantation (TAVI) have been unclear. OBJECTIVES To compare outcomes after TSc/TAx-TAVI versus transfemoral (TF)-TAVI, transapical (TAp)-TAVI, or transaortic (TAo)-TAVI, we performed meta-analysis of currently available studies. METHODS Studies considered for inclusion met the following criteria: the study population was patients undergoing TAVI; patients were assigned to TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least one of postprocedural early (30-day or in-hospital) or late (including early) outcomes was reported. An odds or hazard ratio of each early or late outcome with its 95% confidence interval for TSc/TAx-TAVI versus the other approach was extracted from each individual study and combined in the random-effects model. RESULTS Our search identified 15 eligible reports from 12 studies including 10,528 patients. Pooled analysis of early all-cause mortality demonstrated a statistically significant reduction after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.003) or TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.0001) or TAo-TAVI (P < 0.00001). Pooled analysis of midterm all-cause mortality demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007). CONCLUSIONS Early all-cause mortality was lower after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm all-cause mortality was higher after TSc/TAx-TAVI than TF-TAVI.
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DeAndrade DS, Smith NF, McHugh SM. Airway Compression During Transcatheter Aortic Valve Replacement via Subclavian Artery Approach: A Case Report. A A Pract 2019; 12:329-331. [PMID: 30431441 DOI: 10.1213/xaa.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an alternative to traditional surgery in patients considered to be at high or intermediate risk for open surgical repair of aortic stenosis. Despite its overall safety and efficacy, TAVR is associated with potentially serious complications including major vascular injury. Tracheal compression resulting from vascular pathology has been previously reported; however, airway compromise secondary to vascular injury during TAVR has not been described. We report a case of airway compression and respiratory compromise resulting from injury to the right subclavian artery during TAVR.
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Affiliation(s)
- Diana S DeAndrade
- From the Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas F Smith
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen M McHugh
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Chakravarty T, Jilaihawi H, Doctor N, Fontana G, Forrester JS, Cheng W, Makkar R. Complications after Transfemoral Transcatheter Aortic Valve Replacement with a Balloon-Expandable Prosthesis: The Importance of Preventative Measures and Contingency Planning. Catheter Cardiovasc Interv 2019; 91:E29-E42. [PMID: 23436313 DOI: 10.1002/ccd.24888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 01/11/2013] [Accepted: 02/17/2013] [Indexed: 12/19/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) with balloon-expandable Edwards-SAPIEN valve was superior to standard therapy in inoperable patients and noninferior to surgical aortic valve replacement in high surgical-risk, but operable patients, with severe symptomatic aortic stenosis in the randomized controlled PARTNER trial. Since the first case of TAVR with a balloon-expandable valve in 2002, several groups have reported their experience with balloon-expandable valves with high-procedural success. In the United States, the balloon-expandable Edwards-SAPIEN valve is the only transcatheter heart valve approved by the FDA for commercial use. Moreover, this is only in high-risk inoperable patients. Despite increasing experience with the TAVR procedure, it can be associated with complications, which can be technically challenging, even for an experienced operator. Complications associated with TAVR include vascular complications, valve malpositioning, regurgitation, embolization, coronary compromise, conduction abnormalities, stroke/transient ischemic attack, acute kidney injury, cardiac tamponade, and hemodynamic collapse. A thorough understanding of the procedure is essential for pre-emptive planning for procedural complications and early identification and management of complications are necessary for procedural success. We hereby review our experience of transfemoral TAVR with balloon-expandable valves, offer practical tips to maximize the likelihood of procedural success, describe pre-emptive strategies to prevent peri-procedural complications and bailout measures to manage them, should they occur. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Niraj Doctor
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | | | - Wen Cheng
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California
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Nazif TM, Chen S, George I, Dizon JM, Hahn RT, Crowley A, Alu MC, Babaliaros V, Thourani VH, Herrmann HC, Smalling RW, Brown DL, Mack MJ, Kapadia S, Makkar R, Webb JG, Leon MB, Kodali SK. New-onset left bundle branch block after transcatheter aortic valve replacement is associated with adverse long-term clinical outcomes in intermediate-risk patients: an analysis from the PARTNER II trial. Eur Heart J 2019; 40:2218-2227. [DOI: 10.1093/eurheartj/ehz227] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/02/2018] [Accepted: 04/01/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Transcatheter aortic valve replacement (TAVR) is now an established therapy for intermediate-risk surgical candidates with symptomatic, severe aortic stenosis. The clinical impact of new-onset left bundle branch block (LBBB) after TAVR remains controversial and has not been studied in intermediate-risk patients. We therefore sought to analyse outcomes associated with new LBBB in a large cohort of intermediate-risk patients treated with TAVR.
Methods and results
A total of 2043 patients underwent TAVR in the PARTNER II trial and S3 intermediate-risk registry and survived to hospital discharge. Patients were excluded from the current analysis due to baseline conduction disturbances, pre-existing permanent pacemaker (PPM), and new PPM during the index hospitalization. Clinical outcomes at 2 years were compared between patients with and without persistent, new-onset LBBB at hospital discharge, and multivariable analysis was performed to identify predictors of mortality. Among 1179 intermediate-risk patients, new-onset LBBB at discharge occurred in 179 patients (15.2%). Patients with new LBBB were similar to those without except for more frequent diabetes and more frequent treatment with SAPIEN 3 vs. SAPIEN XT. At 2 years, new LBBB was associated with increased rates of all-cause mortality (19.3% vs. 10.8%, P = 0.002), cardiovascular mortality (16.2% vs. 6.5%, P < 0.001), rehospitalization, and new PPM implantation. By multivariable analysis, new LBBB remained an independent predictor of 2-year all-cause [hazard ratio (HR) 1.98, 95% confidence interval (95% CI) 1.33, 2.96; P < 0.001] and cardiovascular (HR 2.66 95% CI 1.67, 4.24; P < 0.001) mortality. New LBBB was also associated with worse left ventricular systolic function at 1 and 2-year follow-up.
Conclusions
In a large cohort of intermediate-risk patients from the PARTNER II trial and registry, persistent, new-onset LBBB occurred in 15.2% of patients without baseline conduction disturbances or pacemaker. New LBBB was associated with adverse clinical outcomes at 2 years, including all-cause and cardiovascular mortality, rehospitalization, new pacemaker implantation, and worsened left ventricular systolic function.
Clinical Trial Registration
ClinicalTrials.gov #NCT01314313 and NCT03222128.
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Affiliation(s)
- Tamim M Nazif
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | - Shmuel Chen
- Cardiovascular Research Foundation, New York, NY, USA
| | - Isaac George
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | - Jose M Dizon
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | - Aaron Crowley
- Cardiovascular Research Foundation, New York, NY, USA
| | - Maria C Alu
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | | | - Vinod H Thourani
- Medstar Heart & Vascular Institute/Washington Hospital Center, Washington, DC, USA
| | - Howard C Herrmann
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard W Smalling
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | | | - Raj Makkar
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - John G Webb
- St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Martin B Leon
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | - Susheel K Kodali
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
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Kawashima H, Watanabe Y, Kataoka A, Kozuma K. Unexpected massive pleural effusion leading to discovery of left subclavian artery rupture during transcatheter aortic valve implantation. J Cardiol Cases 2019; 19:136-139. [DOI: 10.1016/j.jccase.2018.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/23/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022] Open
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Dahle TG, Kaneko T, McCabe JM. Outcomes Following Subclavian and Axillary Artery Access for Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:662-669. [DOI: 10.1016/j.jcin.2019.01.219] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/30/2018] [Accepted: 01/15/2019] [Indexed: 11/24/2022]
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Shreenivas S, Schloss E, Choo J, Sarembock I, Lilly S, Kereiakes D. Transcatheter aortic valve replacement and cardiac conduction. Expert Rev Cardiovasc Ther 2019; 17:293-304. [DOI: 10.1080/14779072.2019.1598264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Satya Shreenivas
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Edward Schloss
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Joseph Choo
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Ian Sarembock
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dean Kereiakes
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
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Staniloae CS, Jilaihawi H, Amoroso NS, Ibrahim H, Hisamoto K, Sin DN, Lee H, Du R, Zhao ZG, Neuburger PJ, Williams MR. Systematic Transfemoral Transarterial Transcatheter Aortic Valve Replacement in Hostile Vascular Access. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2018.1556828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Cezar S. Staniloae
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Hasan Jilaihawi
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Nicholas S. Amoroso
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Homam Ibrahim
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Kazuhiro Hisamoto
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Danielle N. Sin
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Hanah Lee
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Run Du
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Zhen-Gang Zhao
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Peter J. Neuburger
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Mathew R. Williams
- Department of Cardiothoracic Surgery and Department of Medicine, NYU Langone Health, New York, New York, USA
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Anselmi A, Tomasi J, Giardinelli F, Bedossa M, Rosier S, Verhoye JP. Safety and effectiveness of the transsubclavian approach for transcatheter aortic valve implantation with the 14-F CoreValve Evolut R device. J Cardiovasc Med (Hagerstown) 2018; 19:664-668. [DOI: 10.2459/jcm.0000000000000706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Anselmi A, Dachille A, Auffret V, Harmouche M, Roisne A, Bedossa M, Le Breton H, Verhoye JP. Evolution of Length of Stay After Surgical and Transcatheter Aortic Valve Implantation Over 8 Years in 1,849 Patients >75 Years of Age and Comparison Between Transfemoral and Transsubclavian Transcatheter Aortic Valve Implantation. Am J Cardiol 2018; 122:1387-1393. [PMID: 30107906 DOI: 10.1016/j.amjcard.2018.06.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 11/25/2022]
Abstract
Minimized length of hospitalization (LoS) and lower risk of hospitalization-related complications are key requirements in the treatment of aortic valve disease, mainly in the elderly candidates. Our objective was to evaluate evolution of LoS after surgical (SAVR) or transcatheter aortic valve implantation (TAVI) and its predictors. We enrolled 1,849 elderly (aged >75) patients receiving SAVR or TAVI from 2009 to 2016. In the surgical cohort (n = 1,006) the mean LoS slightly decreased from 13.81 ± 9.27 days (2009) to 10.96 ± 3.77 (2016); in the TAVI cohort (n = 843), LoS passed from 13.33 ± 9.17 (2009) to 6.21 ± 4.30 days (2016). All-cause mortality at 1 month was 3.77 % (SAVR) versus 4.7% (TAVI) (p >0.05). Among Transfemoral TAVI (TF, n = 681), and Transsubclavian TAVI (TS, n = 62), average LoS was comparable (7.38 days ± 7.11 vs 7.31 ± 4.32; median 6.0 and 6.0 days, p = 0.07). Procedural success was reached in 93% (TF) and in 85.4% (TS) (p = 0.20). There were no meaningful differences among TF and TS in terms of VARC-2 postprocedural morbidity, except for the rate of vascular access-related complications; these occurred in 8.8% of cases in the TF group versus 1.6% in the TS group (p = 0.05). In conclusion the present analysis showed a faster improvement in terms of LoS for TAVI compared with SAVR over 8 years of activity. The 2 strategies presented comparable all-causes mortality at 30 days. LoS, rates of procedural success and complications were comparable among TF and TS TAVI; nonetheless, vascular access-related complications were more frequent in the TF cohort. This suggests the validity of the TS route as an alternative to the TF approach.
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Hysi I, Gommeaux A, Pécheux M, Hochart P, Hannebicque G, Pâris M, Manchuelle A, Fabre O. Axillary Transcatheter Aortic Valve Replacement in Patients With Peripheral Vascular Disease. Semin Thorac Cardiovasc Surg 2018; 31:175-180. [PMID: 30291887 DOI: 10.1053/j.semtcvs.2018.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/21/2018] [Indexed: 02/04/2023]
Abstract
The axillary artery seems an interesting alternative in nonfemoral transaortic valve replacement (TAVR) patients. This study describes our experience with this technique and its short-term follow-up results. This is a retrospective single center study. All axillary TAVR performed in our department between 2015 and 2017 were included in the study. Mean follow-up was 13.2 ± 9.5 months. All reporting was done according to the VARC-2 criteria. During the period covered, 43 patients had an axillary TAVR. Most patients were men (62.7%), had a mean age of 83.9 ± 5.3 years and presented with EuroSCORE I, II, and STS score of 27.9 ± 13.5%, 5.6 ± 4.9%, and 7.7 ± 4.05%, respectively. Vascular access was successful in all patients with a higher frequency of left approach (69.7%, n = 30). Both Medtronic CoreValve 37.2% (n = 16) and Edwards Sapien3 62.8% (n = 27) valves were used. An apical Certitude delivery system was preferentially used (24/27) in the latter group. There were no reported instances of valve migration or need for a second valve implantation. A single case (2.3%) of arterial vascular complication was reported. Central neurologic morbidity was 2.3%. No patient experienced brachial plexus injury. A pacemaker was implanted in 18.6% of cases (n = 8), with no significant difference between the 2 valves patient groups (S3 14.8% vs CV 25%, P 0.67). The 30-day mortality was 6.9% (n = 3) and 1-year survival was 86% [95% CI 72.6, 93.4]. Axillary TAVR is associated with acceptable morbidity, mortality, and leads to satisfactory short-term clinical outcomes. It has the potential to become the main alternative access route in nonfemoral TAVR patients.
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Affiliation(s)
- Ilir Hysi
- Departement of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, France.
| | - Antoine Gommeaux
- Departement of Cardiology, Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, France
| | - Max Pécheux
- Deparetement of Cardiology, Centre Hospitalier de Lens, Lens, France
| | - Philippe Hochart
- Departement of Cardiology, Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, France
| | - Géry Hannebicque
- Departement of Cardiology, Centre Hospitalier d'Arras, Lens, France
| | - Marc Pâris
- Departement of Cardiology, Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, France
| | - Aurélie Manchuelle
- Departement of Cardiology, Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, France
| | - Olivier Fabre
- Departement of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, France
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Feasibility and Outcomes of Transcatheter Aortic Valve Implantation Using the Left Axillary Artery as Primary Access Site. Ann Thorac Surg 2018; 107:546-552. [PMID: 30292844 DOI: 10.1016/j.athoracsur.2018.07.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The femoral artery is generally used as primary access for transcatheter aortic valve implantation. However, peripheral artery disease often precludes femoral access. The purpose of this study was to describe clinical outcome of transcatheter aortic valve implantation using the left axillary artery (LAA) as primary access site. METHODS From December 2008 until June 2016, data on all consecutive patients treated with a Medtronic device through the LAA at our hospital were registered, and outcome was prospectively collected according to the updated Valve Academic Research Consortium-2 criteria. Mortality check was performed nationally. RESULTS In total, 362 patients were included (median age 80 years [range, 76 to 84]; logistic European System for Cardiac Operative Risk Evaluation 17% ± 12%). Successful axillary access was achieved in 99%. Medtronic CoreValve (86%) and Evolut R (14% [Medtronic, Minneapolis, MN]) were implanted. Major vascular complications occurred in 5% of patients, 1% was LAA related. Life-threatening bleeding and major bleeding were observed in 2% and 10%, respectively. Additional complications were new left bundle branch blood (30%), new permanent pacemaker (11%), and stroke (1%). There were 6 procedural deaths (2%) and 19 deaths (5%) within 30 days. One-year mortality rate was 19%. CONCLUSIONS This is the first study reporting outcome after transcatheter aortic valve implantation using the LAA as default access. We conclude that it is highly feasible and safe with low rates of major vascular complications, bleeding, and stroke.
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Khan AA, Kovacic JC, Engstrom K, Stewart A, Anyanwu A, Basnet S, Aquino M, Baber U, Garcia L, Gidwani U, Dangas G, Kini A, Sharma S. Comparison of Transaortic and Subclavian Approaches for Transcatheter Aortic Valve Replacement in Patients with No Transfemoral Access Options. STRUCTURAL HEART 2018. [DOI: 10.1080/24748706.2018.1497237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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A Review of Alternative Access for Transcatheter Aortic Valve Replacement. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:62. [PMID: 29974264 DOI: 10.1007/s11936-018-0648-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
With the advent of transcatheter aortic valve replacement (TAVR), appropriately selected intermediate-, high-, and extreme-risk patients with severe aortic stenosis (AS) are now offered a less invasive option compared to conventional surgery. In contemporary practice, TAVR is performed predominantly via a transfemoral arterial approach, whereby a transcatheter heart valve (THV) is delivered in a retrograde fashion through the iliofemoral arterial system and thoraco-abdominal aorta, into the native aortic valve annulus. While the majority of patients possess suitable anatomy for transfemoral arterial access, there is a subset of patients with extensive peripheral vascular disease that precludes this traditional approach to TAVR. Fortunately, innovation in the field of structural heart disease has led to the refinement of alternative access options for THV delivery. Selection of the most appropriate route of therapy mandates a careful consideration of multiple factors, including patient anatomy, technical feasibility, and equipment specifications. Furthermore, understanding the risks conferred by each access site for valve delivery-notably stroke, vascular injury, and major bleeding-is of paramount importance when selecting the approach that will best optimize the outcome for an individual. In this review, we provide a comprehensive summary of alternative approaches to transfemoral arterial TAVR as well as the available outcome data supporting each of these various techniques.
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Mangieri A, Montalto C, Pagnesi M, Lanzillo G, Demir O, Testa L, Colombo A, Latib A. TAVI and Post Procedural Cardiac Conduction Abnormalities. Front Cardiovasc Med 2018; 5:85. [PMID: 30018969 PMCID: PMC6038729 DOI: 10.3389/fcvm.2018.00085] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/12/2018] [Indexed: 01/20/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a worldwide accepted alternative for treating patients at intermediate or high risk for surgery. In recent years, the rate of complications has markedly decreased except for new-onset atrioventricular and intraventricular conduction block that remains the most common complication after TAVI. Although procedural, clinical, and electrocardiographic predisposing factors have been identified as predictors of conduction disturbances, new strategies are needed to avoid such complications, particularly in the current TAVI era that is moving quickly toward the percutaneous treatment of low-risk patients. In this article, we will review the incidence, predictive factors, and clinical implications of conduction disturbances after TAVI.
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Affiliation(s)
| | | | | | | | - Ozan Demir
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Azeem Latib
- IRCCS San Raffaele Scientific Institute, Milan, Italy
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Madigan M, Atoui R. Non-transfemoral access sites for transcatheter aortic valve replacement. J Thorac Dis 2018; 10:4505-4515. [PMID: 30174904 DOI: 10.21037/jtd.2018.06.150] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transfemoral access is currently the standard and preferred access site for transcatheter aortic valve replacement (TAVR), though novel approaches are emerging to expand treatment options for the increasing numbers of patients with a contraindication for the traditional route. Previous publications have provided comparisons between two TAVR access sites, primarily transfemoral versus one of the novel approaches, while others have compared three or four novel approaches. The aim of this report is to provide a comprehensive summary of publications that analyse and compare the six non-transfemoral access sites currently described in the literature. These include the transapical, transaortic, axillary/subclavian, brachiocephalic, transcarotid, and transcaval approaches. Though there remains little consensus as to the superiority or non-inferiority of TAVR approaches, and there has yet to be randomized clinical trials to support published findings, with careful patient and procedural selection, outcomes for novel approaches have been reported to be comparable to standard transfemoral access when performed by skilled physicians. As such, choice of procedure is primarily based on registry data and the judgement of surgical teams as to which approach is best in each individual case. As TAVR continues to be an increasingly widespread treatment, search for the optimal access site will grow, and focus should be placed on the importance of educating surgeons as to all possible approaches so they may review and chose the most appropriate technique for a given patient.
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Affiliation(s)
- Mariah Madigan
- Division of Cardiac Surgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Rony Atoui
- Division of Cardiac Surgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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