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Wilimski R, Huczek Z, Grodecki K, Kochman J, Rymuza B, Wojakowski W, Hudziak D, Jagielak D, Sacha J, Grygier M, Walczak A, Hendzel P, Cichoń R, Grabowski M, Kuśmierczyk M. Nationwide experience with transcarotid transcatheter aortic valve implantation: Insights from the POL-CAROTID registry. Kardiol Pol 2023; 81:373-380. [PMID: 36594529 DOI: 10.33963/kp.a2022.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND: To investigate the feasibility and safety of transcarotid (TC) access for transcatheter aortic valve implantation (TAVI) in comparison to the transfemoral (TF) approach in a multicenter setting. METHODS: A total of 41 patients, treated between December 2014 and December 2018, were retrospectively reported to the Polish Registry of Common Carotid Artery Access for TAVI (POL-CAROTID). The median follow-up time was 619 (365 - 944) days and Valve Academic Research Consortium-2 (VARC-2) definitions were applied. Clinical outcomes were compared with 41 propensity-matched TF-TAVI patients. RESULTS: The mean (SD) patients' age was 78.0 (7.2) years and 29 patients (70.7%) were men. Prohibitive iliofemoral anatomy and/or obesity (46.3%) and/or the presence of stent graft in the abdominal aorta (31.7%) were the most common indications for TC-TAVI. Device success for TC-TAVI was comparable with matched TF-TAVI group (90.2% vs 95.3%, P=0.396) and no periprocedural mortality was observed. Moreover, early safety was similar between the two groups (92.7% vs 95.3%, respectively, log-rank P=0.658) with only 1 case of non-disabling stroke during the first month after TC-TAVI. Consequently, no cerebrovascular events were observed in the mid-term, and the clinical efficacy of TC-TAVI corresponded well with TF-TAVI (90.2% vs 92.7%, log-rank P=0.716). A total of 4 (9.8%) deaths were noted in the TC-TAVI cohort in comparison to 3 (7.3%) in the TF-TAVI group. CONCLUSIONS: The results of the study indicated that the first cohort of transcarotid transcatheter heart valves of second-generation implantations in Poland were associated with a similar prognosis to TF-TAVI with regard to safety and feasibility. TC access may be considered an optimal alternative for patients, in whom the TF approach is precluded.
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Affiliation(s)
- Radoslaw Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Warszawa, Poland.
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Bartosz Rymuza
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland
| | - Damian Hudziak
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Jerzy Sacha
- Department of Cardiology, University Hospital, Faculty of Natural Sciences and Technology, University of Opole, Opole, Poland.,Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Andrzej Walczak
- Department of Cardiac Surgery, Medical University of Lodz, Łódź, Poland
| | - Piotr Hendzel
- Department of Cardiac Surgery, Medical University of Warsaw, Warszawa, Poland
| | - Romuald Cichoń
- Department of Cardiac Surgery, Medical University of Zielona Góra, Zielona Góra, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Mariusz Kuśmierczyk
- Department of Cardiac Surgery, Medical University of Warsaw, Warszawa, Poland
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Khatri D, Javed K, Jalloh M, Fluss R, Haranhalli N, Altschul D. Transcarotid access for the treatment of recurrent, previously ruptured wide necked bifurcation aneurysm with the WEB device: A technical video. Interv Neuroradiol 2022:15910199221127060. [PMID: 36112869 DOI: 10.1177/15910199221127060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
The Woven Endobridge (WEB) device is an FDA-approved intrasaccular flow disruptor to treat most intracranial wide-necked bifurcation aneurysms.1 Based on the rising experience with safe and effective results, it has been increasingly utilized for the treatment of residual and recurrent aneurysms.2, 3 Additionally, the device has been reported as an off-label treatment option for Posterior communicating (Pcom) artery aneurysms with optimal morphology.4 A transfemoral or transradial artery access is conventionally utilized for WEB embolization.1- 3 In this technical video, we share our experience with the use of direct carotid puncture to perform WEB embolization for a large recurrent Pcom aneurysm in an elderly female with a history of subarachnoid hemorrhage that was initially treated with surgical clipping. A direct puncture of the left common carotid artery (CCA) under ultrasound guidance was performed after failed attempts to select the left ICA via both transfemoral and transradial access due to type 3 aortic arch and extreme tortuosity of the proximal left CCA. The aneurysm was successfully treated with a 5 mm × 2 mm WEB SL device. There are limited studies of transcarotid access for neurointerventional procedures including mechanical thrombectomy, intracranial stent placement etc.5, 6 To the best of our knowledge, this technical video represents the first documented report of WEB embolization via transcarotid access. We aim to highlight the feasibility of transcarotid arterial access for WEB embolization as an effective bailout strategy. In addition, the nuances of direct carotid puncture along with possible complications, and potential management strategies have been discussed.
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Affiliation(s)
- Deepak Khatri
- Department of Radiology, 2013Montefiore Medical Center, Bronx, NY, USA
- Department of Neurological Surgery, 2013Montefiore Medical Center, Bronx, NY, USA
| | - Kainaat Javed
- Department of Neurological Surgery, 2013Montefiore Medical Center, Bronx, NY, USA
| | - Mohamad Jalloh
- Department of Neurological Surgery, 2013Montefiore Medical Center, Bronx, NY, USA
| | - Rose Fluss
- Department of Neurological Surgery, 2013Montefiore Medical Center, Bronx, NY, USA
| | - Neil Haranhalli
- Department of Neurological Surgery, 2013Montefiore Medical Center, Bronx, NY, USA
| | - David Altschul
- Department of Neurological Surgery, 2013Montefiore Medical Center, Bronx, NY, USA
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Hudziak D, Targoński R, Wańha W, Gocoł R, Hajder A, Parma R, Figatowski T, Darocha T, Deja MA, Wojakowski W, Jagielak D. Comparison of transcarotid versus transapical transcatheter aortic valve implantation outcomes in patients with severe aortic stenosis and contraindications for transfemoral access. Cardiol J 2021; 30:188-195. [PMID: 34308536 PMCID: PMC10129253 DOI: 10.5603/cj.a2021.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/12/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the safety and clinical outcomes of transcarotid (TC) and transapical access (TA) transcatheter aortic valve implantation (TAVI) patients whom the transfemoral approach (TF) was not feasible. METHODS The analysis included consecutive patients with severe symptomatic aortic stenosis treated from 2017 to 2020 with TC-TAVI or TA-TAVI in two high-volume TAVI centers. The approach was selected by multidisciplinary heart teams after analyzing multislice computed tomography of the heart, aorta and peripheral arteries, transthoracic echocardiography and coronary angiography. RESULTS One hundred and two patients were treated with alternative TAVI accesses (TC; n = 49 and TA; n = 53) in our centers. The groups were similar regarding age, gender, New York Heart Association class, and echocardiography parameters. Patients treated with TC-TAVI had significantly higher surgical risk. The procedural success rate was similar in both groups (TC-TAVI 98%; TA-TAVI 98.1%; p = 0.95). The rate of Valve Academic Research Consortium-2 defined clinical events was low in both groups. The percentage of new-onset rhythm disturbances and permanent pacemaker implantation was similar in TC and TA TAVI (4.1% vs. 11.3%; p = 0.17 and 10.2% vs. 5.7%; p = 0.39, respectively). In the TA-TAVI group, significantly more cases of pneumonia and blood transfusions were observed (11% vs. 0%; p = 0.01 and 30.2% vs. 12.2%; p = 0.03). The 30-day mortality was similar in TC and TA groups (4.1% vs. 5.7%; p = 0.71, respectively). CONCLUSION Both TC and TA TAVI are safe procedures in appropriately selected patients and are associated with a low risk of complications.
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Affiliation(s)
- Damian Hudziak
- Department of Cardiac Surgery Medical University of Silesia, Katowice, Poland.
| | | | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland
| | - Radosław Gocoł
- Department of Cardiac Surgery Medical University of Silesia, Katowice, Poland
| | - Adrianna Hajder
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland
| | - Radosław Parma
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland
| | - Tomasz Figatowski
- First Department of Cardiology, Medical University of Gdansk, Poland
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Marek A Deja
- Department of Cardiac Surgery Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland
| | - Dariusz Jagielak
- Department of Cardiac & Vascular Surgery Medical University of Gdansk
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Hudziak D, Hajder A, Gocol R, Malinowski M, Kazmierski M, Morkisz L, Ciosek J, Wanha W, Jarosinski G, Parma R, Darocha T, Wojakowski W. Long-Term Clinical Outcomes and Carotid Ultrasound Follow-Up of Transcarotid TAVI. Prospective Single-Center Registry. J Clin Med 2021; 10:1499. [PMID: 33916515 PMCID: PMC8038472 DOI: 10.3390/jcm10071499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to prospectively evaluate the safety and long-term clinical outcomes of cerebral-oximetry-guided transcarotid transcatheter aortic valve implantation (TC-TAVI) with systematic follow-up with carotid ultrasound. Thirty-three TCTAVI procedures were performed in our center from 2017 to 2019. Our analysis includes in-hospital outcomes and long-term follow-up data on mortality, echocardiographic parameters, carotid Doppler ultrasound, and VARC-2 defined clinical events. Intraoperatively, one patient died, and one had a transient ischemic attack (TIA). The following events occurred in-hospital postoperatively: myocardial infarction (3.0%), cardiac tamponade (3.0%), new-onset atrial fibrillation (6.3%), need for temporary pacing (27.3%) and need for pacemaker implantation (15%). The mean follow-up was 19.5 ± 9.52 months. In the long-term follow-up, the two-year survival rate was 83% ± 14. The echocardiographic parameters did not differ significantly from the postprocedural values, and the ultrasound did not show any cases of significant vessel narrowing. The mean peak systolic velocity (PSV) was 71.6 cm/s in the left common carotid artery and 70.6 cm/s in the right common carotid artery. In conclusion, cerebral oximetry-guided TC access is safe, has a favorable long-term outcome, and does not increase the risk of plaque formation in the carotid artery. In a carefully selected group of patients, it might be considered as a first-choice alternative to TF access.
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Affiliation(s)
- Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Adrianna Hajder
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Radoslaw Gocol
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Marcin Malinowski
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Maciej Kazmierski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Lukasz Morkisz
- Department of Cardiac Surgery, Medical University of Silesia, 40-007 Katowice, Poland; (R.G.); (M.M.); (L.M.)
| | - Joanna Ciosek
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Wojciech Wanha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Grzegorz Jarosinski
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-007 Katowice, Poland;
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, 40-007 Katowice, Poland;
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-007 Katowice, Poland; (M.K.); (J.C.); (W.W.); (R.P.); (W.W.)
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Hudziak D, Wańha W, Gocoł R, Parma R, Ochała A, Smolka G, Ciosek J, Darocha T, Deja MA, Wojakowski W. Short-term safety and efficacy of transcarotid transcatheter aortic valve implantation with balloon-expandable vs. self-expandable valves. Postepy Kardiol Interwencyjnej 2021; 17:75-81. [PMID: 33868421 DOI: 10.5114/aic.2021.104772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Transfemoral access (TF) is the preferred access for transcatheter aortic valve implantation (TAVI). Transcarotid TAVI (TC-TAVI) is an alternative for patients in whom TF-TAVI is impossible. Two types of valves – balloon-expandable (BE) and self-expandable (SE) – can be used in TC-TAVI procedures. Aim Comparison of the short-term results of patients treated with TC-TAVI using BE and SE valves. Material and methods The retrospective registry included 39 patients in whom the TC-TAVI procedure was performed between 2017 and 2020 (BE-TAVI; n = 10, SE-TAVI; n = 29). Preoperative characteristics, operative and postoperative results, and 30-days mortality were compared. Results Patients from the BE-TAVI group had higher surgical risk (EuroSCORE) (10.8% (6.2–14.0) vs. 5.5% (4.3–8.7); p = 0.027). The incidence of chronic obstructive pulmonary disease (COPD) was higher in the SE-TAVI group (34.5% vs. 0%; p = 0.040). In terms of other comorbidities, demographics, preprocedural laboratory results, transthoracic echocardiography (TTE), and multislice computed tomography (MSCT), the two groups were comparable. In both groups, we observed 100% procedural success. The median valve size was larger in the SE-TAVI group (29.0 (26.0–29.0) vs. 26.0 (23.0–26.0); p < 0.001). The hospitalization time was shorter in the BE-TAVI group vs. SE-TAVI (5.8 ±0.6 vs. 6.4 ±0.9; p = 0.043). We did not observe statistically significant differences between BE-TAVI and SE-TAVI in periprocedural and 30-day mortality, or the number of strokes/TIA. Also TTE parameters and NYHA class showed similar improvement at 30 days in both groups. Conclusions TC-TAVI using balloon-expandable and self-expandable valves showed similar safety and efficacy in 30 days follow-up.
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Stavropoulou D, Hentschel R, Rädecke J, Kunze M, Niemeyer C, Uhl M, Grohmann J. Preoperative selective embolization with vascular coiling of giant sacrococcygeal teratoma. J Neonatal Perinatal Med 2020; 12:345-349. [PMID: 30932896 DOI: 10.3233/npm-180066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sacrococcygeal teratoma is one of the most common congenital tumors. Its optimal management requires interdisciplinary care by obstetricians, radiologists, pediatric surgeons, and neonatologists. Early surgery entailing complete tumor excision is the main therapy aim, but a substantial risk of life-threatening complications remains, especially uncontrollable intraoperative hemorrhage. To reduce the risk of bleeding in a female neonate with a giant sacrococcygeal teratoma, we successfully coil-embolized the tumor's main feeding arteries. Her subsequent complete surgical resection was uneventful, and the child is well with favorable reconstructive and functional status of all involved and adjacent organ systems.
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Affiliation(s)
- D Stavropoulou
- Department of General Pediatrics, Adolescent Medicine, Division of Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Hentschel
- Department of General Pediatrics, Adolescent Medicine, Division of Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Rädecke
- Department of Pediatric Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Kunze
- Department of Obstetrics and Gynecology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Niemeyer
- Department of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Uhl
- Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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