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Rosseel L, Montarello NJ, Nuyens P, Tirado-Conte G, Quagliana A, Cornelis K, Floré V, Rosseel M, Bieliauskas G, Sondergaard L, De Backer O. A systematic algorithm for large-bore arterial access closure after TAVI: the TAVI-MultiCLOSE study. EUROINTERVENTION 2024; 20:e354-e362. [PMID: 37982158 PMCID: PMC10949328 DOI: 10.4244/eij-d-23-00725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Despite transcatheter aortic valve implantation (TAVI) having become a routine procedure, access site bleeding and vascular complications are still a concern which contribute to procedure-related morbidity and mortality. AIMS The TAVI-MultiCLOSE study aimed to assess the safety and efficacy of a new vascular closure algorithm for percutaneous large-bore arterial access closure following transfemoral (TF)-TAVI. METHODS All consecutive TF-TAVI cases in which the MultiCLOSE vascular closure algorithm was used were prospectively included in a multicentre, observational study. This stepwise algorithm entails the reinsertion of a 6-8 Fr sheath (primary access) following the initial preclosure with one or two suture-based vascular closure devices (VCDs). This provides the operator with the opportunity to perform a quick and easy angiographic control and tailor the final vascular closure with either an additional suture- or plug-based VCD, or neither of these. RESULTS Among 630 patients who underwent TF-TAVI utilising the MultiCLOSE algorithm, complete arterial haemostasis was achieved in 616 patients (98%). VCD failure occurred in 14 patients (2%), treated with either balloon inflation (N=1), covered stent (N=12) or surgical repair (N=1). Overall, this vascular closure approach resulted in a minor and major vascular complication rate of 2.2% and 0.6%, respectively. At 30 days, only one new minor vascular complication (0.2%) was noted. In-hospital and 30-day all-cause mortality rates were 0.2% and 1.0%, respectively. CONCLUSIONS Use of the MultiCLOSE vascular closure algorithm was demonstrated to contribute to an easy, safe, efficacious and durable vascular closure after TF-TAVI, resulting in a major vascular complication rate of less than 1%.
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Affiliation(s)
- Liesbeth Rosseel
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Cardiology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - Nicholas J Montarello
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Angelo Quagliana
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristoff Cornelis
- Cardiology Department, Algemeen Ziekenhuis Maria Middelares, Ghent, Belgium
| | - Vincent Floré
- Cardiology Department, Algemeen Ziekenhuis Maria Middelares, Ghent, Belgium
| | - Michael Rosseel
- Cardiology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Murthy K, Kumar J R, Kaur N, Chadha A, Chauhan R, Chadha D. Suture-Based Vascular Closure Versus Surgical Closure of Large Bore Arteriotomies: A Real-World Experience. Cureus 2024; 16:e54856. [PMID: 38533167 PMCID: PMC10964123 DOI: 10.7759/cureus.54856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION With the introduction of transcatheter aortic valve implantation (TAVI), endovascular abdominal aortic aneurysm repair (EVAR), thoracic endovascular aortic aneurysm repair (TEVAR), and frequent use of left ventricular assist devices in complicated percutaneous coronary interventions, the use of large bore arterial access has become a necessity. In the index study, we compared the percutaneous closure of large arteriotomies with open surgical (OS) closure. METHODS It was a prospective study in which we compared the technical success and vascular complication rate associated with the use of a suture-based vascular closure device (VCD): Perclose ProGlide (PP) with that of OS closure. The study was carried out at Command Hospital Air Force, Bengaluru, India, from January 1, 2016, to December 31, 2020. The inclusion criteria were any percutaneous intervention involving large bore arterial access (≥12 French (F) sheath). The exclusion criteria were any condition where a persistent need for vascular access at the end of the procedure was required. We noted the baseline characteristics and type of anesthesia for all patients. The primary outcome was technical success and major vascular complications, which included major local site bleeding: Bleeding Academic Research Consortium (BARC) 3 or more, failed hemostasis requiring a second intervention, and acute vessel occlusion. Total time taken for the procedure (TTP), time to ambulation (TTA), and time to discharge post-procedure (TTD) were noted for each patient. The secondary outcomes were any bleeding other than major, local hematoma sized >5 cm at 24 hours, pseudo aneurysm formation at 30 days, and acute limb ischemia at 30 days. RESULTS A total of 120 patients (PP: 60 (males: 54, females: 6), OS: 60 (males: 50, females: 10)) were included in this study. The mean age of patients was comparable in both groups (PP: 71.8 ± 9.62 years and OS: 71.0 ± 7.76 years, p-value: 0.63). Total large arteriotomies (mean size: 18.03F ± 3.34) closed were 184 (PP: 90, OS: 94). The procedures performed were EVAR: 64 (PP: 30, OS: 34), TAVI: 38 (PP: 21, OS: 17), and TEVAR: 18 (PP: 9, OS: 9). All patients in PP group received dual ProGlide with preclose technique. All TEVAR procedures (total arteriotomies: 18) required a vascular sheath of ≥ 24F. There was no statistical difference between the mean size of sheaths used in the two groups. The technical success (PP: 95.55%, OS: 97.87%, 95% CI: -5.78%-10.98%, p-value: 0.48) and rate of major complications were similar in both groups. Three patients in the PP group who had failed hemostasis with two ProGlides were successfully managed with one additional Angioseal (6F) each. The occurrence of hematoma sized larger than 5 cm was significantly more in the PP group compared to the OS group (PP: 7 (7.78%), OS: 0 (0%), p-value: 0.006). While GA was used for all patients who underwent vascular closure with OS, only eight patients (13.33%) in the PP group required GA. The TTP, TTA, and TTD were significantly lower in the PP group as compared to the OS group. CONCLUSION The percutaneous closure of large bore arteriotomies with suture-based VCDs is equally effective and is not associated with increased major vascular complications. In fact, the TTP, TTA, and TTD are significantly lower in the PP group which can translate to better patient comfort and lower costs.
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Affiliation(s)
- Keshava Murthy
- Cardiology Department, Army Hospital Research and Referral, New Delhi, IND
| | - Ratheesh Kumar J
- Cardiology Department, Army Hospital Research and Referral, New Delhi, IND
| | - Navjyot Kaur
- Cardiology Department, Command Hospital Air Force, Bengaluru, IND
| | - Amitoj Chadha
- Emergency Department, St. John's Medical College, Bengaluru, IND
| | - Rajeev Chauhan
- Cardiology Department, Command Hospital Air Force, Bengaluru, IND
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Naoum I, Eitan A, Galili O, Hayeq H, Shiran A, Zissman K, Sliman H, Jaffe R. Strategy for Totally Percutaneous Management of Vascular Injury in Combined Transfemoral Transcatheter Aortic Valve Replacement and Endovascular Aortic Aneurysm Repair Procedures. Am J Cardiol 2023; 207:130-136. [PMID: 37738782 DOI: 10.1016/j.amjcard.2023.08.148] [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: 07/25/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/24/2023]
Abstract
Minimally invasive treatment of severe aortic stenosis by transcatheter aortic valve replacement (TAVR) and infrarenal abdominal aortic aneurysm by endovascular aortic aneurysm repair (EVAR) requires large-bore vascular access. These percutaneous transfemoral interventions may be performed as a combined procedure, however, vascular injury may necessitate surgical vascular repair. We implemented a strategy designed to enable percutaneous vascular repair, with stent-graft implantation, if necessary, after these combined procedures. We identified all combined percutaneous TAVR and EVAR procedures which were performed at our institution. Patient and procedural characteristics and clinical outcomes were analyzed. Six consecutive patients underwent total percutaneous combined TAVR and EVAR procedures. In all cases, TAVR was performed first and was followed by EVAR. Both common femoral arteries served as primary access sites for delivery of the implanted devices and hemostasis was achieved by deployment of vascular closure devices. Secondary access sites included the right brachial artery in all patients and superficial femoral arteries in 50% of the patients. In all cases an "0.014" 300-cm length "safety" wire was delivered to the common femoral artery or descending aorta by way of a secondary access site to facilitate stent graft delivery. Successful device implantation was achieved in all cases. Vascular closure device failure occurred in 2 patients and was treated by stent graft implantation by way of the brachial and superficial femoral arteries, without need for surgical vascular repair. A strategy designed to facilitate percutaneous vascular repair after combined EVAR and TAVR procedures may enable a truly minimally invasive procedure.
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Affiliation(s)
| | | | - Offer Galili
- Department of Vascular & Endovascular Surgery, Carmel Medical Center, Haifa, Israel
| | - Hashem Hayeq
- Department of Vascular & Endovascular Surgery, Carmel Medical Center, Haifa, Israel
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Mousa MA, Zahwy SSE, Tamara AF, Samir W, Tantawy MA. A comparative study between surgical cut down and percutaneous closure devices in management of large bore arterial access. CVIR Endovasc 2023; 6:53. [PMID: 37899370 PMCID: PMC10613603 DOI: 10.1186/s42155-023-00395-6] [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: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Compared to conventional open surgery, minimally invasive catheter-based procedures have less post procedural complications. Transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (EVAR) require large bore arterial access. Optimal site management of large bore arterial access is pivotal to reduce the hospital-acquired complications associated with large bore arterial access. We wanted to compare surgical cutdown versus percutaneous closure devices in site management of large bore arterial access. METHODS Participants planned for TAVI or EVAR with large bore arterial access more than 10 French were included, while participants with history of bypass surgery, malignancies, thrombophilia, or sepsis were excluded. A consecutive sample of 100 participants (mean age 74.66 ± 2.65 years, 61% males) was selected, underwent TAVI or EVAR with surgical cutdown (group 1) versus TAVI or EVAR with Proglide™ percutaneous closure device (group 2). RESULTS The incidence rate of hematoma was significantly lower in group 2 versus group 1 (p = 0.014), the mean procedure time (minutes) and the median hospital stay (days) were significantly higher in group 1 versus group 2 (t(98) = - 2.631, p = 0.01, and U = 2.403, p = 0.018, respectively), and the c-reactive protein pre-procedure and the c-reactive protein post-procedure were significantly lower in group 2 versus group 1 (U = -2.969, p = 0.003, and U = -2.674, p = 0.007, respectively). CONCLUSIONS Our study showed a lower incidence rate of large bore arterial access complications as hematoma, a shorter procedure time, and a shorter hospital stay with percutaneous closure devices compared to surgical cutdown.
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Affiliation(s)
- Mohamed Ahmed Mousa
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Ahmed Fathy Tamara
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wafed Samir
- Deaprtment of Cardiology, Faculty of Medicine, Misr University for Science and Technology, 6th of October, Egypt
| | - Mahmoud Ahmed Tantawy
- Deaprtment of Cardiology, Faculty of Medicine, Misr University for Science and Technology, 6th of October, Egypt
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Sakata T, Kuno T, Fujisaki T, Yokoyama Y, Misumida N, Sugiura T, Latib A. Selection of Vascular Closure Devices in Transcatheter Aortic Valve Replacement: Systematic Review and Network Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:78-84. [PMID: 35970699 DOI: 10.1016/j.carrev.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023]
Abstract
Various vascular closure devices (VCDs) are commonly used for percutaneous transcatheter aortic valve replacement (TAVR). However, superiority and safety profile among them remain unclear. We compared periprocedural complications among various VCDs in patients undergoing TAVR. PubMed and EMBASE were searched through January 2022 to identify clinical studies comparing any 2 VCDs of Prostar, Proglide and MANTA in patients who underwent TAVR. Studies using surgical cut-down or alternative access other than transfemoral approach were excluded. We analyzed the odds ratios (ORs) of vascular complications (VC), bleeding, acute kidney injury and all-cause mortality using a network meta-analysis. All outcomes were defined by Valve Academic Research Consortium 2 criteria. Two randomized controlled trials and 15 observational studies were identified, yielding a total of 11,344 patients including Prostar (n = 4499), Proglide (n = 5705), or MANTA group (n = 1140). The rates of major VC and life-threatening and major bleeding were significantly lower in Proglide compared to Prostar (OR [95 % CI] = 0.54 [0.32-0.89], 0.68 [0.52-0.90], and 0.49 [0.26-0.95], respectively). There was no significant difference in major VC and bleeding between Proglide and MANTA groups. Proglide was associated with a lower rate of acute kidney injury (0.56 [0.34-0.92]) and red blood cell transfusion (0.39 [0.16-0.98]) compared to Prostar. There was no significant difference in additional interventions and 30-day overall mortality among three groups. In this network meta-analysis of VCD in patients undergoing TAVR, MANTA and Proglide had comparable outcomes while Proglide appears superior to Prostar in terms of major VC and bleeding.
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Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA.
| | - Tomohiro Fujisaki
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, USA
| | - Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, PA, USA
| | - Naoki Misumida
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, USA
| | - Tadahisa Sugiura
- Department of Cardiothoracic & Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
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Montalto C, Munafò AR, Arzuffi L, Soriano F, Mangieri A, Nava S, De Maria GL, Burzotta F, D’Ascenzo F, Colombo A, Latib A, Oreglia JA, Banning AP, Porto I, Crimi G. Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac043. [PMID: 36117948 PMCID: PMC9472788 DOI: 10.1093/ehjopen/oeac043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/27/2022] [Indexed: 02/03/2023]
Abstract
Aims As the indications to transcatheter aortic valve replacement (TAVR) expand to patients at increasingly lower risk, procedure-related vascular and bleeding complications events must be minimized. We aimed to evaluate the impact of different large-bore arterial access closure devices on clinical outcomes after TAVR. Methods and results We searched for papers that reported outcomes according to the type of vascular closure device/technique used after TAVR and performed a Bayesian network meta-analysis (NMA). Fifteen studies involving 9259 patients who underwent access site closure using PROSTAR™ XL percutaneous vascular surgical system (Abbott Vascular, Santa Clara, CA, USA), Perclose ProGlide™ suture-mediated closure system (Abbott), or MANTATM vascular closure device (Teleflex, Morrisville, NC, USA) were included. NMA showed MANTA to have the highest likelihood of reducing a primary composite endpoint of intra-hospital death, major vascular complications, and major or life-threatening bleedings [surface under the cumulative ranking curve analysis (SUCRA) 94.8%], but this was mitigated when only randomized clinical trials and propensity-matched cohorts were included (SUCRA 56.1%). The ProGlide showed the highest likelihood to reduce major or life-threatening bleedings, especially with increasing procedural complexity, and the MANTA device to reduce major and minor vascular complications. The ProStar XL device performed poorly in all explored endpoints. Conclusion Available evidence summarized through a NMA shows that ProGlide and MANTA devices appear to be both valid vascular closure devices globally and to be the best options to minimize vascular complications and reduce bleeding in patients undergoing TAVR, respectively.
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Affiliation(s)
- Claudio Montalto
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy,De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, 20172 Milan, Italy
| | | | | | - Francesco Soriano
- De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, 20172 Milan, Italy
| | | | - Stefano Nava
- De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, 20172 Milan, Italy
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, 10126 Turin, Italy,Cardiology, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | | | - Azeem Latib
- Montefiore Medical Center, New York 10467, USA
| | - Jacopo Andrea Oreglia
- De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, 20172 Milan, Italy
| | - Adrian P Banning
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford OX3 9DU, UK
| | | | - Gabriele Crimi
- Division of Cardiovascular Medicine, Policlinico San Martino, University of Genova, 16132 Genova, Italy
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Eitan A, Sliman H, Shiran A, Jaffe R. Strategies for Facilitating Totally Percutaneous Transfemoral TAVR Procedures. J Clin Med 2022; 11:jcm11082104. [PMID: 35456197 PMCID: PMC9028438 DOI: 10.3390/jcm11082104] [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: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 02/01/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and should ideally be performed as a totally percutaneous procedure via the transfemoral (TF) approach. Peripheral vascular disease may impede valve delivery, and vascular access site complications are associated with adverse clinical outcome and increased mortality. We review strategies aimed to facilitate TF valve delivery in patients with hostile vascular anatomy and achieve percutaneous management of vascular complications.
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OUP accepted manuscript. Eur Heart J 2022; 43:2729-2750. [DOI: 10.1093/eurheartj/ehac105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/22/2022] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
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Bansal A, Kalra A, Kumar A, Campbell J, Krishnaswamy A, Kapadia SR, Reed GW. Outcomes of Combined Transcatheter Aortic Valve Replacement and Peripheral Vascular Intervention in the United States. JACC Cardiovasc Interv 2021; 14:2572-2580. [PMID: 34774477 DOI: 10.1016/j.jcin.2021.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to compare the prevalence and real-world outcomes of patients who require peripheral vascular intervention during the same hospitalization as transcatheter aortic valve replacement (TAVR) compared with TAVR alone. BACKGROUND There are limited data on the prevalence and outcomes of combined TAVR and percutaneous peripheral vascular intervention. METHODS All patients who underwent TAVR in 2016 and 2017 were identified using the Nationwide Readmissions Database. Outcomes of patients undergoing TAVR alone were compared with those of patients undergoing combined TAVR and peripheral intervention, TAVR and peripheral intervention with and without a history of peripheral artery disease, and alternative-access TAVR with transfemoral TAVR in individuals undergoing peripheral intervention. The primary outcome was in-hospital mortality. RESULTS A total of 99,654 hospitalizations were identified, among which 4,397 patients (4.42%) underwent peripheral intervention during the same admission as TAVR. Patients who required peripheral intervention had increased mortality (4.2% vs 1.5%; P < 0.001), stroke (3.5% vs 1.8%; P < 0.001), acute kidney injury (17.6% vs 10.8%; P < 0.001), blood transfusion (16.0% vs 11.3%; P < 0.001), 30-day readmission (16.3% vs 12.1%; P < 0.001), median length of stay (4 days [IQR: 2-8 days] vs 3 days [IQR: 2-5 days]; P < 0.001), and hospitalization charges. Compared with patients undergoing peripheral intervention to facilitate transfemoral TAVR, alternative-access TAVR was associated with increased mortality (4.6% vs 3.0%; P = 0.036), acute kidney injury (22.7% vs 14.3%; P < 0.001), median length of stay (5 days [IQR: 3-10 days] vs 4 days [IQR: 2-7 days]; P < 0.001), and 30-day readmission (18.1% vs 15.5%; P = 0.012). CONCLUSIONS Peripheral vascular intervention may be used to facilitate transfemoral access or as a bailout for vascular complications during TAVR. Combined TAVR and peripheral intervention is associated with an increased risk for adverse events, though outcomes are better compared with alternative-access TAVR using a nonfemoral approach.
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Totally Percutaneous Transfemoral Transcatheter Aortic Valve Replacement Despite Failure to Deploy a Vascular Closure Device: A Single-Center Case Series. Heart Lung Circ 2021; 31:390-394. [PMID: 34607752 DOI: 10.1016/j.hlc.2021.09.005] [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: 05/15/2021] [Revised: 07/27/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is preferably performed as a completely percutaneous procedure via transfemoral access. Suture-mediated vascular closure devices are deployed prior to sheath insertion (pre-closure). Inability to perform pre-closure may necessitate surgical vascular repair of the femoral artery. Patients at increased risk of vascular surgery complications may benefit from a percutaneous method for achieving access site haemostasis. Stent graft implantation is commonly used for treating access site injury following TAVR. This study assessed the feasibility of a strategy of planned stent graft implantation within the femoral artery for achieving access site haemostasis in patients undergoing transfemoral TAVR and in whom vascular pre-closure was not possible. METHODS A prospective institutional TAVR registry was retrospectively analysed and a cohort of patients were identified who were selected for transfemoral valve delivery and in whom pre-closure failed and access site haemostasis was achieved by stent graft implantation. RESULTS This strategy was used for achieving access site haemostasis in 11 patients (1.5% of 744 patients undergoing transfemoral TAVR). These patients were considered to be at increased risk of vascular surgery complications due to advanced age, frailty, comorbidities, or immobility. Stent graft implantation achieved access site haemostasis in all patients. During follow-up, 30-day mortality was zero, 1-year mortality was 27%, and none of the patients required additional vascular interventions. CONCLUSION The preliminary data suggest that planned stent graft implantation within the femoral artery may achieve access site haemostasis and enable a totally percutaneous TAVR procedure, despite failure to perform pre-closure with a suture-based vascular closure device.
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11
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Choi CH, Hall JK, Malaver D, Applegate RJ, Zhao DXM. A novel technique for postclosure of large-bore sheaths using two Perclose devices. Catheter Cardiovasc Interv 2021; 97:905-909. [PMID: 33098361 DOI: 10.1002/ccd.29351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study aimed to assess the feasibility, efficacy, and safety of a novel percutaneous postprocedure closure technique for large arterial sheath removal with the use of two Perclose ProGlide (Abbott Vascular Devices, Redwood City, CA) devices. BACKGROUND Postprocedural closing of large-bore arteriotomies using the Perclose system can be difficult given the subsequent inability of the device to capture sufficient wall tissue. METHODS Our study was a single-center retrospective analysis of 22 consecutive patients who underwent large arteriotomy closure via the postclosure technique with a 12-16-Fr sheath. Efficacy endpoints included successful deployment of the system and hemostasis. Safety endpoints included the incidence of major or minor vascular complications as defined by the Vascular Academic Research Consortium-2 (VARC-2) definitions at 30-day follow-up. RESULTS The postclosure technique resulted in 100% technical success rate and no postprocedural bleeding or vascular complications. CONCLUSION Postclosure technique is a safe, highly effective, and feasible percutaneous method to achieve large-bore arteriotomy hemostasis with low rates of major bleeding or vascular complications and favorable early outcome.
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Affiliation(s)
- Charles H Choi
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - James Kevin Hall
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Diego Malaver
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Robert J Applegate
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - David X M Zhao
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina
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12
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Comparison between Surgical Access and Percutaneous Closure Device in 787 Patients Undergoing Transcatheter Aortic Valve Replacement. J Clin Med 2021; 10:jcm10071344. [PMID: 33805069 PMCID: PMC8037566 DOI: 10.3390/jcm10071344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The vascular access in transcatheter aortic valve replacement (TAVR) was initially dominated by a surgical approach. Meanwhile, percutaneous closure systems became a well-established alternative. The aim of this study was to compare the clinical outcome between the two approaches. METHODS In this retrospective study, we observed 787 patients undergoing a TAVR-Procedure between 2013 and 2019. Of those, 338 patients were treated with surgical access and 449 with the Perclose ProGlide™-System (Abbott, Chicago, IL, USA). According to the Bleeding Academic Research Consortium (BARC) and Valve Academic Research Consortium (VARC) criteria, the primary combined endpoints were defined. RESULTS Overall hospital mortality was 2.8% with no significant difference between surgical (3.8%) and percutaneous (2.2%) access (p = 0.182). Major vascular complications or bleeding defined as the primary combined endpoint was not significantly different in either group (Surgical group 5.3%, ProGlide group 5.1%, p = 0.899). In the ProGlide group, women with pre-existing peripheral artery disease (PAD) were significantly more often affected by a vascular complication (p = 0.001 for female sex and p = 0.03 for PAD). CONCLUSIONS We were able to show that the use of both accesses is safe. However, the surgical access route should also be considered in case of peripheral artery disease.
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Gennari M, Rigoni M, Mastroiacovo G, Trabattoni P, Roberto M, Bartorelli AL, Fabbiocchi F, Tamborini G, Muratori M, Fusini L, Pepi M, Muti P, Polvani G, Agrifoglio M. Proper Selection Does Make the Difference: A Propensity-Matched Analysis of Percutaneous and Surgical Cut-Down Transfemoral TAVR. J Clin Med 2021; 10:jcm10050909. [PMID: 33669044 PMCID: PMC7956334 DOI: 10.3390/jcm10050909] [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: 12/22/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022] Open
Abstract
Background. Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosis patients with a wide range of surgical risk. Currently, the common femoral artery is the first choice as the main access route for the procedure. The objective of this observational study is to report our experience on percutaneous and surgical cut-down transfemoral TAVRs comparing the two approaches. Methods. From January 2014 to January 2019, five hundred eleven consecutive patients underwent TAVR for severe symptomatic aortic stenosis. We analyzed only elective transfemoral procedures. After propensity score-matching based on age, sex, EuroSCORE II, mean aortic gradient, and left ventricular ejection fraction, we obtained two homogeneous populations: surgical cut-down (n = 119) and percutaneous (n = 225), which were labeled Group 1 and Group 2, respectively. Results. The main findings were that there were no significant procedural outcome differences between the two groups, but Group 2 patients had a shorter length of hospital stay and were more frequently discharged home. At follow-up, Group 1 patients had lower survival rates. Conclusions. An accurate preoperative assessment of the femoral access is mandatory to achieve satisfactory outcomes with transfemoral TAVRs. Nevertheless, the percutaneous approach allows shorter in-hospital stay and the need for rehabilitation, thus potentially decreasing the costs of the procedure.
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Affiliation(s)
- Marco Gennari
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.M.); (P.T.); (M.R.); (M.A.)
- Correspondence: ; Tel.: +39-02-58-0022-96
| | - Marta Rigoni
- Department of Industrial Engineering, University of Trento, 38100 Trento, Italy;
- Department of Oncology and Health, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Giorgio Mastroiacovo
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.M.); (P.T.); (M.R.); (M.A.)
| | - Piero Trabattoni
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.M.); (P.T.); (M.R.); (M.A.)
| | - Maurizio Roberto
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.M.); (P.T.); (M.R.); (M.A.)
| | - Antonio L. Bartorelli
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20100 Milan, Italy;
| | - Franco Fabbiocchi
- Department of Invasive Cardiology, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy;
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.T.); (M.M.); (L.F.)
| | - Manuela Muratori
- Department of Cardiovascular Imaging, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.T.); (M.M.); (L.F.)
| | - Laura Fusini
- Department of Cardiovascular Imaging, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.T.); (M.M.); (L.F.)
| | - Mauro Pepi
- Clinical Area Director, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy;
| | - Paola Muti
- Department of Oncology and Health, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy;
| | - Gianluca Polvani
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy;
- Chief of Cardiovascular Surgery Department, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy
| | - Marco Agrifoglio
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.M.); (P.T.); (M.R.); (M.A.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy;
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Chiam PTL, Hayashida K, Watanabe Y, Yin WH, Kao HL, Lee MKY, Posas FE, Chandavimol M, Buddhari W, Dy TC, Nguyen NQ, Kim WJ, Chang K, Lin MS, Lam YY, Pham HM, Yahaya SA, Ho KW, Pan W, Liu XB, Wang J, Kim HS, Chen M. Sex differences in patients undergoing transcatheter aortic valve replacement in Asia. Open Heart 2021; 8:openhrt-2020-001541. [PMID: 33419935 PMCID: PMC7798412 DOI: 10.1136/openhrt-2020-001541] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives Transcatheter aortic valve replacement (TAVR) is increasingly performed. Physically small Asians have smaller aortic root and peripheral vessel anatomy. The influence of gender of Asian patients undergoing TAVR is unknown and may affect outcomes. The aim of this study was to assess sex differences in Asian patients undergoing TAVR. Methods Patients undergoing TAVR from eight countries were enrolled. In this retrospective analysis, we examined differences in characteristics, 30-day clinical outcomes and 1-year survival between female and male Asian patients. Results Eight hundred and seventy-three patients (54.4% women) were included. Women were older, smaller and had less coronary artery and lung disease but tended to have higher logistic EuroSCOREs. Smaller prostheses were used more often in women. Major vascular complications occurred more frequently in women (5.5% vs 1.8%, p<0.01); however, 30-day stroke and mortality (women vs men: 1.5% vs 1.6%, p=0.95% and 4.3% vs 3.4%, p=0.48) were similar. Functional status improvement was significant and comparable between the sexes. Conduction disturbance and permanent pacemaker requirements (11.2% vs 9.0%, p=0.52) were also similar as was 1-year survival (women vs men: 85.6% vs 88.2%, p=0.25). The only predictors of 30-day mortality were major vascular injury in women and age in men. Conclusions Asian women had significantly smaller stature and anatomy with some differences in clinical profiles. Despite more frequent major vascular complications, women had similar 30-day stroke or mortality rates. Functional status improvement was significant and comparable between the sexes. Conduction disturbance and permanent pacemaker requirements were similar as was 1-year survival.
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Affiliation(s)
- Paul T L Chiam
- The Heart and Vascular Centre, Mount Elizabeth Medical Centre, Singapore
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Michael K Y Lee
- Department of Cardiology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | | | | | | | - Timothy C Dy
- Heart Institute, Chinese General Hospital and Medical Centre, Manila, Philippines
| | - Ngoc Quang Nguyen
- Department of Cardiology, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Won Jang Kim
- Department of Cardiology, CHA Bundang Medical Centre, Seoul, Republic of Korea
| | - Kiyuk Chang
- Cardiology, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yat-Yin Lam
- Hong Kong Asia Heart Centre, Canossa Hospital, Hong Kong, Hong Kong
| | - Hung Manh Pham
- Department of Cardiology, Vietnam National Heart Institute, Hanoi, Vietnam
| | | | - Kay Woon Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xian-Bao Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hyo Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mao Chen
- Department of Cardiology, Sichuan University West China Hospital, Chengdu, China
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15
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Kumar V, Sandhu GS, Harper CM, Ting HH, Rihal CS. Analysis of the Changing Economics of US Hospital Transcatheter Aortic Valve Replacement Programs. Mayo Clin Proc 2021; 96:174-182. [PMID: 33168158 DOI: 10.1016/j.mayocp.2020.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022]
Abstract
New technologies in medicine, even if they are promising medically, are often expensive and logistically difficult to implement at the hospital level. Transcatheter aortic valve replacement (TAVR) is a model technology that is revolutionary in treating aortic stenosis, but has been plagued with significant challenges with financial sustainability. In this article, a margin analysis at the hospital level was performed using literature data. A TAVR industry analysis was performed using Porter's Five Forces framework. The data indicate that TAVR is more expensive than surgical aortic valve replacement, although the cost of TAVR is declining with the use of an optimized minimalist protocol. The overall industry is growing as its clinical indications expand, and it will likely undergo significant reduction of costs when new valves enter the US market. As such, TAVR is a growing industry, with financial sustainability currently dependent on operational efficiency. A concluding list of specific program interventions is provided to help TAVR programs improve operational efficiency and clinical outcomes, as well as help decide whether to create, expand, or redirect funding for TAVR programs. Importantly, the frameworks used to analyze this rapidly evolving technology can be applied to other new technologies to determine financial sustainability.
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Affiliation(s)
| | | | | | - Henry H Ting
- Department of Cardiology, Mayo Clinic, Rochester, MN
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16
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Parker MH, Mukherjee D, Ryan L. Management of large bore access complications in the era of trans-catheter aortic valve replacement. Vascular 2020; 29:610-615. [PMID: 33148138 DOI: 10.1177/1708538120969468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Trans-catheter aortic valve replacement is a commonplace procedure for patients with aortic valvular stenosis who are at a high risk for surgery, evidenced by the 34,892 trans-catheter aortic valve replacements performed in 2016. Trans-catheter aortic valve replacement's rate of major vascular complications with second-generation closure devices is 4.5% according to a meta-analysis of 10,822 patients. To manage those complications, percutaneous approaches to arterial repairs show shorter length of stay, higher rate of direct to home discharge and equivalent outcomes at long-term follow-up. This study's goal is to show that one center's vascular access strategy can decrease open repairs and improve patient outcomes. METHODS Our team began accessing the mid-common femoral artery at least 1-2 cm proximal to the takeoff of the profunda femoris. This allowed an endovascular stent to be deployed if necessary via contralateral femoral access. We performed a completion angiogram following every trans-catheter aortic valve replacement to ensure no arterial complications. We conducted a retrospective review of a prospectively maintained database for all trans-catheter aortic valve replacement cases at a tertiary care center from 1 January 2016 to 30 June 2018. RESULTS A total of 699 trans-catheter aortic valve replacement procedures were performed with 25/31 (80.6%) cases met inclusion criteria. An increase was noted in the number of stent procedures versus cutdown procedures over time (P < 0.001). A decrease was noted in the number of vascular surgery team activations following trans-catheter aortic valve replacement (P = 0.004). A non-significant trend was noted toward a shorter median length of stay for the stent group (P = 0.149). There was no increase in 30-day mortality rate (0.0% for both groups) or 30-day readmissions (4/15 (26.7%) for stents vs. 2/10 (20.0%) for open repairs; P > 0.999). CONCLUSIONS This strategy is safe and feasible to implement and reduces the number of open repairs following trans-catheter aortic valve replacement, activation of surgical resources, and possibly the length of stay.
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Affiliation(s)
- Michael H Parker
- Department of Surgery, General Surgery, Inova Fairfax, Fairfax, VA, USA
| | - Dipankar Mukherjee
- Department of Surgery, Vascular Surgery, Inova Fairfax, Fairfax, VA, USA
| | - Liam Ryan
- Department of Surgery, Cardiothoracic Surgery, Inova Fairfax, Fairfax, VA, USA
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Kumar V, Sandhu GS, Harper CM, Ting HH, Rihal CS. Transcatheter Aortic Valve Replacement Programs: Clinical Outcomes and Developments. J Am Heart Assoc 2020; 9:e015921. [PMID: 32301367 PMCID: PMC7428521 DOI: 10.1161/jaha.120.015921] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcatheter aortic valve replacement is a relatively recent revolutionary treatment that has now become a standard procedure for treating severe aortic stenosis. In this article, the authors review the clinical history of transcatheter aortic valve replacement, summarize the major clinical trials, and describe the evolution of the technique over time. In doing so, the authors hope to provide a clear and concise review of the history and clinical evidence behind transcatheter aortic valve replacement.
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Affiliation(s)
| | | | | | - Henry H Ting
- Department of Cardiology Mayo Clinic Rochester MN
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18
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Abdelaziz HK, Megaly M, Debski M, Rahbi H, Kamal D, Saad M, Wiper A, More R, Roberts DH. Meta-Analysis Comparing Percutaneous to Surgical Access in Trans-Femoral Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:1239-1248. [PMID: 32085864 DOI: 10.1016/j.amjcard.2020.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 12/17/2022]
Abstract
To compare the outcomes in trans-femoral transcatheter aortic valve implantation (TF-TAVI) performed with percutaneous approach (PC) versus surgical cut-down (SC). In 13 trials including 5,859 patients (PC = 3447, SC = 2412), the outcomes based on Valve Academic Research Consortium criteria were compared between PC and SC in TF-TAVI. Compared with SC, PC was associated with similar major vascular complications (VCs) (8.7% vs 8.5%; odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.76 to 1.15, p = 0.53), major bleeding (OR = 1.09, 95% CI = 0.66 to 1.8, p = 0.73), perioperative mortality (5.7% vs 5.2%; OR = 1.13, 95% CI = 0.85 to 1.49, p = 0.4), urgent surgical repair (OR = 1.27, 95% CI = 0.81 to 2.02, p = 0.3), stroke (3.3% vs 3.9%; OR = 0.85, 95% CI = 0.53 to 1.36, p = 0.5), myocardial infarction (1.3% vs 1.1%; OR = 1.06, 95% CI = 0.53 to 2.12, p = 0.86), and renal failure (5.2% vs 5.9%; OR = 0.68, 95% CI = 0.38 to 1.22, p = 0.2), but shorter hospital stay (9.1 ± 8.5 vs 9.6 ± 9.5 days; mean difference = -1.07 day, 95% CI = -2.0 to -0.15, p = 0.02) and less blood transfusion (18.5% vs 25.7%; OR = 0.61, 95% CI = 0.43-0.86, p = 0.005). Minor VCs occurred more frequently in PC compared to SC (11.9% vs 6.9%; OR = 1.67, 95% CI = 1.04-2.67, p = 0.03). In conclusion, in TF-TAVI, PC is a safe and feasible alternative to SC, and adopting either approach depends on operator experience after ensuring that vascular access could be safely achieved with that specific technique.
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Gheorghe L, Brouwer J, Mathijssen H, Nijenhuis VJ, Rensing BJWM, Swaans MJ, Chan Pin Yin DRPP, Heijmen RH, De Kroon T, Sonker U, Van der Heyden JAS, Ten Berg JM. Early Outcomes After Percutaneous Closure of Access Site in Transfemoral Transcatheter Valve Implantation Using the Novel Vascular Closure Device Collagen Plug-Based MANTA. Am J Cardiol 2019; 124:1265-1271. [PMID: 31443900 DOI: 10.1016/j.amjcard.2019.07.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/26/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
A new collagen-based MANTA vascular closure device (VCD) was developed for closing large-bore arteriotomies after transfemoral transcatheter aortic valve implantation (TAVI). We evaluated safety and feasibility at 30-day follow-up in terms of vascular and bleeding complications and mortality of the collagen-based MANTA VCD compared with the suture-based Prostar XL VCD in a cohort of 366 patients who underwent transfemoral TAVI between January 2015 and April 2018. The MANTA VCD was used in 168 patients and the Prostar XL VCD in 198 patients, with successful closure of 98.8% and 98.5%, respectively. VARC-2 defined as major vascular and bleeding complications was similar in both groups (MANTA vs Prostar XL): 0.6% versus 1.0% (p = 0.661) and 0.6% versus 1.5% (p = 0.102). Minor vascular and bleeding complications, were significantly more frequent (10.7 vs 18.8 %, p = 0.003 and 13.7 vs 19.7%, p = 0.080, respectively) in the Prostar XL cohort. Thirty-day all-cause mortality was 2.7%, without significant difference between the groups (p = 0.278). The MANTA device is a safe and feasible option for vascular access closure in patients undergoing transfemoral TAVI.
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