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Gennari M, Maccarana A, Severgnini G, Iennaco V, Bonomi A, Capra N, De Marco F, Muratori M, Fusini L, Polvani G, Agrifoglio M. See It Best: A Propensity-Matched Analysis of Ultrasound-Guided versus Blind Femoral Artery Puncture in Balloon-Expandable TAVI. J Clin Med 2024; 13:1514. [PMID: 38592382 PMCID: PMC10935327 DOI: 10.3390/jcm13051514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Currently, transcatheter aortic valve implantation (TAVI) is the standard procedure recommended for patients over 75 years of age with symptomatic aortic valve stenosis. Percutaneous transfemoral (TF) access is the main route used to perform the procedure. Among periprocedural complications, access-related ones are the most frequent, potentially leading to prolonged in-hospital stays and transfusions. Methods: We performed a retrospective analysis of prospectively collected data on consecutive patients undergoing TF-TAVI with the latest generation balloon-expandable transcatheter valve between 2013 and 2022. Results: A total of 600 patients were analyzed, differentiating the population between ultrasound-guided and blind common femoral artery puncture. Valve Academic Research Consortium 3 (VARC-3)criteria were used to report at 30 days and follow-up. In our propensity-matched comparison of the two groups, we found a strong reduction in access-related complications in the echo-guided group, particularly in terms of reduction of major and minor bleedings. We also found a significant trend in reduction of local complications, such as pseudoaneurysms, hematomas, arterio-venous fistulas, dissection of the femoral or iliac arteries, and stenosis. Conclusions: Although there is a lack of consensus on the role of ultrasound-guided puncture, we found better outcomes for patients having an echo-guided puncture of the main access, particularly with regard to access-related complications, early mobilization, and early discharge home.
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Affiliation(s)
- Marco Gennari
- Centro Cardiologico Monzino IRCCS, Department of Invasive Cardiology, Structural and Valvular Interventional Cardiology Unit, 20138 Milan, Italy;
| | - Agnese Maccarana
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Surgery, 20138 Milan, Italy; (A.M.); (V.I.); (G.P.); (M.A.)
| | - Gaia Severgnini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Surgery, 20138 Milan, Italy; (A.M.); (V.I.); (G.P.); (M.A.)
| | - Vittoria Iennaco
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Surgery, 20138 Milan, Italy; (A.M.); (V.I.); (G.P.); (M.A.)
| | - Alice Bonomi
- Centro Cardiologico Monzino IRCCS, Department of Biostatistics, 20138 Milan, Italy; (A.B.); (N.C.)
| | - Nicolò Capra
- Centro Cardiologico Monzino IRCCS, Department of Biostatistics, 20138 Milan, Italy; (A.B.); (N.C.)
| | - Federico De Marco
- Centro Cardiologico Monzino IRCCS, Department of Invasive Cardiology, Structural and Valvular Interventional Cardiology Unit, 20138 Milan, Italy;
| | - Manuela Muratori
- Centro Cardiologico Monzino IRCCS, Department of Imaging, 20138 Milan, Italy; (M.M.); (L.F.)
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Department of Imaging, 20138 Milan, Italy; (M.M.); (L.F.)
| | - Gianluca Polvani
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Surgery, 20138 Milan, Italy; (A.M.); (V.I.); (G.P.); (M.A.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy
| | - Marco Agrifoglio
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Surgery, 20138 Milan, Italy; (A.M.); (V.I.); (G.P.); (M.A.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy
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Dasi A, Lee B, Polsani V, Yadav P, Dasi LP, Thourani VH. Predicting pressure gradient using artificial intelligence for transcatheter aortic valve replacement. JTCVS Tech 2024; 23:5-17. [PMID: 38352010 PMCID: PMC10859647 DOI: 10.1016/j.xjtc.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 02/16/2024] Open
Abstract
Objective After transcatheter aortic valve replacement, the mean transvalvular pressure gradient indicates the effectiveness of the therapy. The objective is to develop artificial intelligence to predict the post-transcatheter aortic valve replacement aortic valve pressure gradient and aortic valve area from preprocedural echocardiography and computed tomography data. Methods A retrospective study was conducted on patients who underwent transcatheter aortic valve replacement due to aortic valve stenosis. A total of 1091 patients were analyzed for pressure gradient predictions (mean age 76.8 ± 9.2 years, 57.8% male), and 1063 patients were analyzed for aortic valve area predictions (mean age 76.7 ± 9.3 years, 57.2% male). An artificial intelligence learning model was trained (training: n = 663 patients, validation: n = 206 patients) and tested (testing: n = 222 patients) to predict pressure gradient, and a separate artificial intelligence learning model was trained (training: n = 640 patients, validation: n = 218 patients) and tested (testing: n = 205 patients) for predicting aortic valve area. Results The mean absolute error for pressure gradient and aortic valve area predictions was 3.0 mm Hg and 0.45 cm2, respectively. Valve sheath size, body surface area, and age were determined to be the top 3 predictors for pressure gradient, and valve sheath size, left ventricular ejection fraction, and aortic annulus mean diameter were identified to be the top 3 predictors of post-transcatheter aortic valve replacement aortic valve area. A training dataset size of more than 500 patients demonstrated good robustness of the artificial intelligence models for pressure gradient and aortic valve area. Conclusions The artificial intelligence-based algorithm has demonstrated potential in predicting post-transcatheter aortic valve replacement transvalvular pressure gradient predictions for patients with aortic valve stenosis. Further studies are necessary to differentiate pressure gradient between valve types.
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Affiliation(s)
- Anoushka Dasi
- Department of Biomedical Engineering, Ohio State University, Columbus, Ohio
| | - Beom Lee
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | | | - Pradeep Yadav
- Department of Cardiac Surgery, Piedmont Heart Institute, Atlanta, Ga
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Vinod H. Thourani
- Department of Cardiac Surgery, Piedmont Heart Institute, Atlanta, Ga
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The Heart in the Transcatheter Intervention Era: Where Are We? J Clin Med 2022; 11:jcm11175173. [PMID: 36079102 PMCID: PMC9456719 DOI: 10.3390/jcm11175173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
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