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Saad M, Elhakim A, Rusch R, Berndt R, Panholzer B, Lutter G, Frank D. Trans-Brachial TAVI in a Patient with Aortic Isthmus Stenosis: A Case Report. J Clin Med 2024; 13:308. [PMID: 38256442 PMCID: PMC10816714 DOI: 10.3390/jcm13020308] [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: 12/02/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND TAVI indications expand not only to low-risk patients but also to patients with a more complex anatomy and comorbidities. Transfemoral retrograde access is recognized as the first preferred approach according to the current guidelines. However, this approach is not suitable in up to 10-15% of patients, for whom an alternative non-femoral access route is required. CASE PRESENTATION An 83-year-old male patient with known aortic isthmus stenosis presented with severe symptomatic aortic stenosis. Computed tomography revealed a subtotal isthmus stenosis, directly after left subclavian artery origin, with many collaterals extending toward the axillary and subclavian arteries. Duplex ultrasound verified the proximal diameter of the left brachial artery to be 5.5 mm. A successful surgical cutdown trans-brachial TAVI with an Evolut prosthetic valve with a size of 29 mm was performed. On the fourth postoperative day, the patient was discharged, and the three-month follow-up was uneventful. CONCLUSION In patients with aortic isthmus stenosis, the brachial artery could be a feasible alternative, as a less invasive access site, which can be determined after careful assessment of the vessel diameter. More data are required to evaluate the safety and efficacy of this access route and to achieve more technical improvements to increase operator familiarity with it.
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Affiliation(s)
- Mohammed Saad
- Cardiology Department, Schleswig-Holstein University Hospital-Kiel, Arnold-Heller-Street 3, 24105 Kiel, Germany; (A.E.); (D.F.)
| | - Abdelrahman Elhakim
- Cardiology Department, Schleswig-Holstein University Hospital-Kiel, Arnold-Heller-Street 3, 24105 Kiel, Germany; (A.E.); (D.F.)
| | - Rene Rusch
- Vascular Surgery Department, Schleswig-Holstein University Hospital-Kiel, Arnold-Heller-Street 3, 24105 Kiel, Germany; (R.R.); (R.B.)
| | - Rouven Berndt
- Vascular Surgery Department, Schleswig-Holstein University Hospital-Kiel, Arnold-Heller-Street 3, 24105 Kiel, Germany; (R.R.); (R.B.)
| | - Bernd Panholzer
- Cardiothoracic Surgery Department, Schleswig-Holstein University Hospital-Kiel, Arnold-Heller-Street 3, 24105 Kiel, Germany; (B.P.); (G.L.)
| | - Georg Lutter
- Cardiothoracic Surgery Department, Schleswig-Holstein University Hospital-Kiel, Arnold-Heller-Street 3, 24105 Kiel, Germany; (B.P.); (G.L.)
| | - Derk Frank
- Cardiology Department, Schleswig-Holstein University Hospital-Kiel, Arnold-Heller-Street 3, 24105 Kiel, Germany; (A.E.); (D.F.)
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Abellan C, Antiochos P, Fournier S, Skali H, Shah P, Maurizi N, Eeckhout E, Roguelov C, Monney P, Tzimas G, Kirsch M, Muller O, Lu H. Extrathoracic Against Intrathoracic Vascular Accesses for Transcatheter Aortic Valve Replacement: A Systematic Review With Meta-Analysis. Am J Cardiol 2023; 203:473-483. [PMID: 37633682 DOI: 10.1016/j.amjcard.2023.07.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/14/2023] [Indexed: 08/28/2023]
Abstract
Alternative vascular accesses to transfemoral access for transcatheter aortic valve replacement (TAVR) can be divided into intrathoracic (IT)-transapical and transaortic- and extrathoracic (ET)-transcarotid, transsubclavian, and transaxillary. This study aimed to compare the outcomes and safety of IT and ET accesses for TAVR as alternatives to transfemoral access. A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all studies comparing IT-TAVR with ET-TAVR published until April 2023. Outcomes included in-hospital or 30-day all-cause mortality (ACM), 1-year ACM, postoperative and 30-day complications. A total of 18 studies with 6,800 IT-TAVR patients and 5,032 ET-TAVR patients were included. IT accesses were associated with a significantly higher risk of in-hospital or 30-day ACM (relative risk 1.99, 95% confidence interval 1.67 to 2.36, p <0.001), and 1-year ACM (relative risk 1.31, 95% confidence interval 1.21 to 1.42, p <0.001). IT-TAVR patients presented more often with postoperative life-threatening bleeding, 30-day new-onset atrial fibrillation or flutter, and 30-day acute kidney injury needing renal replacement therapy. The risks of postoperative permanent pacemaker implantation and significant paravalvular leak were lower with IT-TAVR. ET-TAVR patients were more likely to be directly discharged home. There was no statistically significant difference regarding the 30-day risk of stroke. Compared with ET-TAVR, IT-TAVR was associated with higher risks of in-hospital or 30-day ACM, 1-year ACM and higher risks for some critical postprocedural and 30-day complications. Our results suggest that ET-TAVR could be considered as the first-choice alternative approach when transfemoral access is contraindicated.
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Affiliation(s)
- Christophe Abellan
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Panagiotis Antiochos
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pinak Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Niccolo Maurizi
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christan Roguelov
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgios Tzimas
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Service of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henri Lu
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease. J Cardiovasc Dev Dis 2022; 9:jcdd9120422. [PMID: 36547419 PMCID: PMC9783693 DOI: 10.3390/jcdd9120422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: Transcatheter aortic valve replacement (TAVR) through alternative access routes is indicated in patients with severe aortic valve stenosis and diseased peripheral arteries. We analysed and compared the outcome of patients undergoing transapical (TA) and direct transaortic (TAO) TAVR procedures. Methods: Preoperative characteristics, procedural details, and thirty-day outcome of patients undergoing transapical (TA-TAVR group) and direct transaortic (TAO-TAVR group) TAVR procedures were prospectively collected and retrospectively analysed. Results: From March 2012 to March 2022, 81 TA and 82 TAO-TAVR (total: 163 cases) were performed with balloon-expanding (n = 120; 73.6%) and self-expandable (n = 43; 26.4%) valves. The mean age was 79.7 ± 6.2 and 81.9 ± 6.7 years for the TA- and TAO-TAVR groups, respectively (p = 0.032). Females were more represented in the TAO-TAVR group (56% vs. 32%; p = 0.003) while TA-TAVR patients showed a higher prevalence of previous vascular surgery (20% vs. 6%; p = 0.01), previous cardiac surgery (51% vs. 3.6%; p < 0.001), and porcelain aorta (22% vs. 5%; p = 0.001). The mean ejection fraction was 49.0 ± 14.6% (TA) and 53.5 ± 12.2% (TAO) (p = 0.035) while mean gradients were 35.6 ± 13.2 mmHg (TA) and 40.4 ± 16.1 mmHg (TAO) (p = 0.045). The median EuroSCORE-II was 5.0% (IQR: 3.0−11.0) and 3.9% (IQR: 2.5−5.4) for the TA- and TAO-TAVR groups, respectively (p = 0.005). The procedural time was shorter for TA procedures (97 min (IQR: 882−118) vs. 102 min (IQR: 88−129); p = 0.133). Mortality at day 30 was 6% in both groups (p = 1.000); the permanent pacemaker implantation rate was similar (8.6% vs. 9.7%; p = 1.000), and hospital stay was shorter for the TAO group (8 days (IQR: 6−11) vs. 10 days (IQR: 7−13); p = 0.025). Conclusions: Our results show that transapical and direct transaortic TAVR in high-risk patients with diseased peripheral arteries provide satisfactory clinical results with similar thirty-day outcomes.
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Stastny L, Krapf C, Dumfarth J, Gasser S, Bauer A, Friedrich G, Metzler B, Feuchtner G, Mayr A, Grimm M, Bonaros N. Minireview: Transaortic Transcatheter Aortic Valve Implantation: Is There Still an Indication? Front Cardiovasc Med 2022; 9:798154. [PMID: 35310977 PMCID: PMC8931192 DOI: 10.3389/fcvm.2022.798154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Transaortic (TAo) transcatheter aortic valve implantation has become a valid alternative access route in patients with unsuitable femoral arteries. The current literature does not allow to clearly favor one of the alternative access routes. Every approach has its specific advantages. Transaortic (TAo) access is of particular importance in the case of calcifications of the supra-aortic branches and the aortic arch, as under these circumstances other alternative access routes, such as transaxillary or transcarotid, are not feasible. The purpose of this minireview is to give an overview and update on TAo transcatheter aortic valve implantation focusing on indication, technical aspects, and recent clinical data.
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Affiliation(s)
- Lukas Stastny
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Krapf
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
- *Correspondence: Julia Dumfarth
| | - Simone Gasser
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Guy Friedrich
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Metzler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
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Kakuta T, Fukushima S, Kawamoto N, Kainuma S, Tadokoro N, Ikuta A, Minami K, Kanzaki H, Amaki M, Okada A, Irie Y, Takagi K, Izumi C, Fujita T. Transaortic Transcatheter Aortic Valve Replacement in Patients From a Single Institution ― Feasibility, Safety, and Midterm Outcomes ―. Circ J 2022; 86:393-401. [DOI: 10.1253/circj.cj-21-0877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
| | - Ayumi Ikuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
| | - Kimito Minami
- Surgical Intensive Care, National Cerebral and Cardiovascular Research Center
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
| | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
| | - Yuki Irie
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Research Center
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center
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Salem M, Grothusen C, Salem M, Frank D, Saad M, Ernst M, Puehler T, Lutter G, Haneya A, Cremer J, Schoettler J. Surgery after Failed Transcatheter Aortic Valve Implantation: Indications and Outcomes of a Concerning Condition. J Clin Med 2021; 11:jcm11010063. [PMID: 35011800 PMCID: PMC8745245 DOI: 10.3390/jcm11010063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The number of transcatheter aortic valve implantations (TAVI) has increased enormously in recent decades. Transcatheter valve prosthesis failure and the requirement of conventional surgical replacement are expected to attract more focus in the near future. Indeed, given the scarcity of research in this field, the next decade will likely represent the beginning of a period of meaningful exploration of the degenerative changes that occur with transcatheter valves. The current study represents-through a series of consecutive cases-one of the first analyses of the underlying causes of TAVI failure, i.e., degenerative, functional and infective, followed by surgical aortic valve replacement (SAVR) and postoperative outcome. METHODS Between October 2008 and March 2021, 2098 TAVI procedures, including 1423 with transfemoral, 309 with transapical, and 366 with transaortic access, were performed in our institution. Among these, 0.5% (number(n) = 11) required acute SAVR (n = 6) within 7 days (n = 3) or later (n = 2), and were included in the study. RESULTS Valve stent dislocation was the most common cause of replacement (83%). Causes of replacement within 7 days after TAVI were multifactorial. In the later course, endocarditis was the sole indication for SAVR after TAVI. TAVI with transapical or transaortal approach had a higher EuroSCORE II (10.9 (7.2-35.3) vs. 3.5 (1.8-7.8)). Their 30-day mortality after surgical conversion was higher (67% vs. 20%), when compared to those who underwent a transfemoral procedure. The longest documented survival beyond 30 days was 58 months. CONCLUSIONS The causes of SAVR after TAVI failure are multifactorial, and include biological, physical and infectious factors. An acceptable midterm prognosis may be expected in patients with physical causes when dislocation of the catheter prosthesis is observed; in such cases, emergency conversion is required. Conversion due to infection, as in cases of endocarditis, had the worst outcome. Prognosis after conversion due to degeneration is still problematic, due to a lack of autopsies and the recent history of prosthetic implantations.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
- Correspondence: ; Tel.: +49-(0431)-5002-2002 (ext. 67089); Fax: +49-(0431)-5002-2004
| | - Christina Grothusen
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
| | - Mostafa Salem
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
| | - Derk Frank
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Mohammed Saad
- Department of Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
| | - Markus Ernst
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
| | - Thomas Puehler
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
| | - Jochen Cremer
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
| | - Jan Schoettler
- Department of Cardiovascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, 24105 Kiel, Germany; (C.G.); (M.E.); (T.P.); (G.L.); (A.H.); (J.C.); (J.S.)
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Payabyab EC, Elbaum LS, Sharma N, George I, Mick SL. Shockwave and Non-transfemoral Transcatheter Aortic Valve Replacement. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2021.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become a widely adopted treatment modality for severe aortic stenosis. Transfemoral access is the approach of choice; however, approximately 25% of patients undergoing TAVR also have concomitant peripheral arterial disease. The recent advent of intravascular lithotripsy has enabled preservation of transfemoral access in some patients; although, a proportion still require alternative, non-femoral access. Alternative access sites can be broadly categorized into transthoracic and peripheral, facilitated by surgical or percutaneous techniques. In this review, the technical details and clinical outcomes of various TAVR accesses are discussed. Initially, transthoracic approaches were most common, but recently, the trend has been toward alternative peripheral access due to superior outcomes. Although there are no randomized data to support all the alternative access sites, the experiences reported provide available options for a large portion of patients to be candidates for TAVR. The intervention site should be selected by a multidisciplinary heart team based on patient anatomical factors and institutional expertise.
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Affiliation(s)
- Eden C Payabyab
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY
| | - Lindsay S Elbaum
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York City, NY
| | - Navneet Sharma
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York City, NY
| | - Isaac George
- NewYork-Presbyterian Hospital, Columbia University Medical Center, New York City, NY
| | - Stephanie L Mick
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY
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Mitsis A, Eftychiou C, Eteokleous N, Papadopoulos K, Zittis I, Avraamides P. Current Trends in TAVI Access. Curr Probl Cardiol 2021; 46:100844. [PMID: 33994035 DOI: 10.1016/j.cpcardiol.2021.100844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
The optimal approach for Transcatheter aortic valve implantation (TAVI) is the transfemoral access but alternative TAVI approaches offer the possibility of valve replacement in patients who are not eligible to the transfemoral route. This review paper intends to compare the current available alternative approaches for TAVI in terms of their safety and efficacy, based on the current literature. The transapical, transaortic, transsubclavian, transcarotid, transcaval and suprasternal approaches have been analyzed. The choice of the alternative approach dependents on local Heart Team expertise, patient specific characteristics, access specific characteristics and the need or not for general anesthesia. More studies are needed to investigate the impact of each individual approach on long-term outcomes.
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Affiliation(s)
- Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, 2029, Nicosia, Cyprus.
| | | | | | | | - Ioannis Zittis
- Cardiology Department, Nicosia General Hospital, 2029, Nicosia, Cyprus
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9
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Shirasaka T, Kunioka S, Kitani Y, Kamiya H. Undeliverable Sapien 3 prosthesis in transaortic transcatheter aortic valve implantation. J Surg Case Rep 2021; 2021:rjab001. [PMID: 33623664 PMCID: PMC7888976 DOI: 10.1093/jscr/rjab001] [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: 12/12/2020] [Accepted: 02/06/2021] [Indexed: 11/12/2022] Open
Abstract
In transaortic (TAo) trasncatheter aortic valve implantation (TAVI), direct transmission of forces to the stenotic aortic valve is possible. Therefore, the need of balloon aortic valvoplasty in TAo-TAVI may be very limited regarding the deliverability of TAVI prosthesis. However, if the TAVI prosthesis becomes undeliverable, it becomes seriously problematic. Herein, we present a case of TAo-TAVI in which the TAVI prosthesis was undeliverable, and it was forcefully pushed together with the introducer system into the aortic valve as a bailout technique.
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Affiliation(s)
- Tomonori Shirasaka
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shingo Kunioka
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yuya Kitani
- Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
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10
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Nijenhuis VJ, Meyer A, Brouwer J, Mahmoodi BK, Unbehaun A, Spaziano M, Buzzatti N, Stundl A, Jørgensen TH, Kooistra NHM, Adamo M, Saraf S, Amrane H, Bruschi G, Zivelonghi C, Swaans MJ, Werner N, Nickenig G, Hildick-Smith D, Stella PR, Latib A, Soendergaard L, Sinning JM, Lefevre T, Pasic M, Kempfert J, Ten Berg JM. The effect of transcatheter aortic valve implantation approaches on mortality. Catheter Cardiovasc Interv 2021; 97:1462-1469. [PMID: 33443813 DOI: 10.1002/ccd.29456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/09/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) approaches on mortality and identify effect modifiers and predictors for mortality. BACKGROUND Alternative access routes to transfemoral (TF) TAVI include the surgical intra-thoracic direct-aortic (DA) and transapical (TA) approach. TA TAVI has been associated with a higher mortality rate. We hypothesized that this is related to effect modifiers, in particular the left ventricular ejection fraction (LVEF). METHODS This multicentre study derived its data from prospective registries. To adjust for confounders, we used propensity-score based, stabilized inverse probability weighted Cox regression models. RESULTS In total, 5,910 patients underwent TAVI via TF (N = 4,072), DA (N = 524), and TA (N = 1,314) access. Compared to TF, 30-day mortality was increased among DA (HR 1.87, 95%CI 1.26-2.78, p = .002) and TA (HR 3.34, 95%CI 2.28-4.89, p < .001) cases. Compared to TF, 5-year mortality was increased among TA cases (HR 1.50, 95%CI 1.24-1.83, p < .001). None of the variables showed a significant interaction between the approaches and mortality. An impaired LVEF (≤35%) increased mortality in all approaches. CONCLUSIONS The surgical intra-thoracic TA and DA TAVI are both associated with a higher 30-day mortality than TF TAVI. TA TAVI is associated with a higher 5-year mortality than TF TAVI. The DA approach may therefore have some advantages over the TA approach when TF access is not feasible.
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Affiliation(s)
- Vincent J Nijenhuis
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Alexander Meyer
- Department of Cardiothoracic Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jorn Brouwer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Axel Unbehaun
- Department of Cardiothoracic Surgery, German Heart Center Berlin, Berlin, Germany
| | - Marco Spaziano
- Department of Cardiology, Hôpital Privé Jacques Cartier, Massy, France
| | - Nicola Buzzatti
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Anja Stundl
- Department of Cardiology, University Bonn, Bonn, Germany
| | | | - Nynke H M Kooistra
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili, University of Brescia, Brescia, Italy
| | - Smriti Saraf
- Department of Cardiology, Royal Sussex County Hospital, Brighton, UK
| | - Hafid Amrane
- Department of Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Giuseppe Bruschi
- "De Gasperis" Cardio Center, ASST Niguarda General Hospital, Milan, Italy
| | | | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Nikos Werner
- Heart Center Trier, Department of Internal Medicine III - Cardiology, Hospital Barmherzige Brüder Trier, Trier, Germany
| | - Georg Nickenig
- Department of Cardiology, University Bonn, Bonn, Germany
| | | | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Thierry Lefevre
- Department of Cardiology, Hôpital Privé Jacques Cartier, Massy, France
| | - Miralem Pasic
- Department of Cardiothoracic Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jorg Kempfert
- Department of Cardiothoracic Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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11
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Edelman JJ, Meduri C, Yadav P, Thourani VH. Current Evidence for Alternative Access Transcatheter Aortic Valve Replacement. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2020.1821936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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12
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Lu H, Muller O, Eeckhout E, Monney P, Roguelov C, Marcucci C, Meziani A, Kirsch M. TAVI : une revue de la littérature des voies alternatives à l’accès trans-fémoral. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.lpmfor.2020.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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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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14
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Gennari M, Giambuzzi I, Polvani G, Agrifoglio M. TAVI-in-homograft (TiH): open transcatheter aortic valve replacement in calcified aortic homograft case reports. J Cardiothorac Surg 2019; 14:208. [PMID: 31775822 PMCID: PMC6881997 DOI: 10.1186/s13019-019-1036-2] [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: 09/05/2019] [Accepted: 11/18/2019] [Indexed: 11/17/2022] Open
Abstract
Background Redo surgery in patient who underwent aortic valve replacement with an aortic homograft can result technically challenging because of the massive calcification of the conduit. Case presentation We present a case of a patient who underwent open surgery on cardiopulmonary bypass assistance to implant a standard transcatheter aortic bioprosthesis through aortotomy in an off-label procedure and we discuss its safety and feasibility. Conclusions The combination of open cardiac surgery and open trans-aortic implant of a transcatheter prosthesis may reduce the surgical risk shrinking the technical difficulties that the implantation of a standard surgical prosthesis would have given.
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Affiliation(s)
- Marco Gennari
- Centro Cardiologico Monzino IRCCS, Via Parea 4 - 20138, Milan, Italy.
| | - Ilaria Giambuzzi
- Centro Cardiologico Monzino IRCCS, Via Parea 4 - 20138, Milan, Italy
| | - Gianluca Polvani
- Centro Cardiologico Monzino IRCCS, Via Parea 4 - 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Agrifoglio
- Centro Cardiologico Monzino IRCCS, Via Parea 4 - 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
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15
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Minimally Invasive Surgical Options with Valvular Heart Disease. Crit Care Nurs Clin North Am 2019; 31:257-265. [DOI: 10.1016/j.cnc.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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16
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Chollet T, Marcheix B, Boudou N, Elbaz M, Campelo-Parada F, Bataille V, Bouisset F, Lairez O, Porterie J, Galinier M, Carrie D, Lhermusier T. Propensity-matched comparison of clinical outcomes after transaortic versus transfemoral aortic valve replacement. EUROINTERVENTION 2019; 14:750-757. [PMID: 29969427 DOI: 10.4244/eij-d-18-00168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to compare the long-term outcomes of transaortic (TAo-AVR) and transfemoral (TF-AVR) transcatheter aortic valve replacement. METHODS AND RESULTS Between January 2012 and December 2015, consecutive TAo-AVR and TF-AVR cases were compared using a propensity score-matching analysis. Primary endpoints were 30-day and one-year mortality; 644 TAVR patients were included (163 TAo-AVR and 481 TF-AVR). Peripheral artery disease (31.9% vs. 5%, p<0.001) and coronary artery disease (50.0% vs. 39.3%, p=0.009) were more frequent in TAo-AVR patients. The Society of Thoracic Surgeons scores were not different (6.9% vs. 6.5%, p=0.243). Propensity matching identified 124 well-matched patient pairs. Thirty-day and one-year mortality rates were similar in the overall population of TAo-AVR and TF-AVR patients (7.3% vs 7.6%, p=0.8 and 18.4% vs. 15.8%, p=0.6, respectively), and in the matched cohort (7.3% vs. 6.5%, p=0.8 and 15.3% vs. 16.1%, p=0.8, respectively). Transaortic access was associated with higher risk of new onset of atrial fibrillation (NOAF) (24.4% vs. 9.6%, p=0.012), life-threatening bleedings (6.5% vs. 0.8%, p=0.036) and transfusion (41% vs. 16.7%, p<0.001). CONCLUSIONS No significant differences were observed between the respective 30-day and one-year mortality rates of TAo-AVR and TF-AVR patients. The transaortic approach thus constitutes a valid alternative to TF-AVR, but is associated with higher rates of NOAF, bleedings, and transfusion.
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Affiliation(s)
- Thomas Chollet
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
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17
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Kakizaki R, Meguro K, Kitamura T, Hashimoto T, Ako J. Transaortic Access Using Vascular Graft for Transcatheter Aortic Valve Implantation. Int Heart J 2019; 60:990-993. [PMID: 31204375 DOI: 10.1536/ihj.18-591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 92-year-old man with acute heart failure due to severe aortic stenosis underwent transcatheter aortic valve implantation (TAVI). Computed tomography demonstrated severe stenosis of the right common iliac artery, occlusion of the left external iliac artery, and stenosis of the left subclavian artery. Severe calcification was observed in the sinotubular junction, which was considered a risk factor for aortic dissection with transapical TAVI using a balloon-expanding bioprosthetic valve. Therefore, transaortic (TAo) access was the only option for this high-risk surgical patient. As the maximum distance from the aortic valve annulus to the sheath insertion point was less than 60 mm, TAVI was performed transaortically using a vascular graft that extended this distance, in order to avoid sheath dislocation. Our experience demonstrates that vascular graft application is a viable option in patients with an inadequate distance between the aortic valve annulus and the puncture site in TAo-TAVI.
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Affiliation(s)
- Ryota Kakizaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Takuya Hashimoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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18
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Baquero GA, Azarrafiy R, Marchena EJ, Carrillo RG. Hybrid off‐pump coronary artery bypass grafting surgery and transaortic transcatheter aortic valve replacement: Literature review of a feasible bailout for patients with complex coronary anatomy and poor femoral access. J Card Surg 2019; 34:591-597. [DOI: 10.1111/jocs.14082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Giselle A. Baquero
- Department of Medicine, Division of CardiologySouthern Illinois University School of MedicineSpringfield Illinois
| | - Ryan Azarrafiy
- Department of Medicine, Division of CardiologyUniversity of Miami Miller School of MedicineMiami Florida
| | - Eduardo J. Marchena
- Department of Medicine, Division of CardiologyUniversity of Miami Miller School of MedicineMiami Florida
| | - Roger G. Carrillo
- Division of Cardiothoracic SurgeryThe Heart Institute at Palmetto General HospitalHialeah Florida
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19
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Axillary/Subclavian Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:670-672. [DOI: 10.1016/j.jcin.2019.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 11/21/2022]
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20
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Lanz J, Greenbaum A, Pilgrim T, Tarantini G, Windecker S. Current state of alternative access for transcatheter aortic valve implantation. EUROINTERVENTION 2018; 14:AB40-AB52. [DOI: 10.4244/eij-d-18-00552] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Biasco L, Ferrari E, Pedrazzini G, Faletra F, Moccetti T, Petracca F, Moccetti M. Access Sites for TAVI: Patient Selection Criteria, Technical Aspects, and Outcomes. Front Cardiovasc Med 2018; 5:88. [PMID: 30065928 PMCID: PMC6056625 DOI: 10.3389/fcvm.2018.00088] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/19/2018] [Indexed: 12/02/2022] Open
Abstract
During the last ten years, transcatheter aortic valve implantation (TAVI) has become a reliable and valid alternative treatment for elderly patients with severe symptomatic aortic valve stenosis requiring valve replacement and being at high or intermediate surgical risk. While common femoral arteries are the access site of choice in the vast majority of TAVI patients, in up to 15–20% of TAVI candidates this route might be precluded due to the presence of diffuse atherosclerotic disease, tortuosity or small vessel diameter. Therefore, in order to achieve an antegrade or retrograde implant, several alterative access routes have been described, namely trans-axillary, trans-aortic, trans-apical, trans-carotid, trans-septal, and trans-caval. The aim of this paper is to give a concise overview on vascular access sites for TAVI, with a particular focus on patient's selection criteria, imaging, technical aspects, and clinical outcome.
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Affiliation(s)
- Luigi Biasco
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Enrico Ferrari
- Division of Cardiovascular Surgery, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Francesco Faletra
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Francesco Petracca
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Marco Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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22
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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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23
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Siordia JA, Loera JM, Scanlon M, Evans J, Knight PA. Three-Year Survival Comparison between Transcatheter and Surgical Aortic Valve Replacement for Intermediate- and Low-Risk Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Juan A. Siordia
- Department of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Jackquelin M. Loera
- Department of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Matt Scanlon
- Department of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Jessie Evans
- Department of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY USA
| | - Peter A. Knight
- Department of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY USA
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24
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Three-Year Survival Comparison between Transcatheter and Surgical Aortic Valve Replacement for Intermediate- and Low-Risk Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:153-162. [DOI: 10.1097/imi.0000000000000507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transcatheter aortic valve implantation is a suitable therapeutic intervention for patients deemed inoperable or high risk for surgical aortic valve replacement. Current investigations question whether it is a suitable alternative to surgery for intermediate- and low-risk patients. The following meta-analysis presents a comparison between transcatheter versus surgical aortic valve replacement in patients that are intermediate and low risk for surgery. Articles were collected via an electronic search using Google Scholar and PubMed. Articles of interest included studies comparing the survival of intermediate- and low-risk patients undergoing transcatheter aortic valve implantation to those undergoing surgical aortic valve replacement. Primary end points included 1-, 2-, and 3-year survival. Secondary end points included postintervention thromboembolic events, stroke, transient ischemic attacks, major vascular complications, permanent pacemaker implantation, life-threatening bleeding, acute kidney injury, atrial fibrillation, and moderate-to-severe aortic regurgitation. Six studies met the criteria for the meta-analysis. One- and two-year survival comparisons showed no difference between the two interventions. Surgical aortic valve replacement, however, presented with favorable 3-year survival compared with the transcatheter approach. Transcatheter aortic valve implantation had more major vascular complications, permanent pacemaker implantation, and moderate-to-severe aortic regurgitation rates compared with surgery. Surgical aortic valve replacement presented more life-threatening bleeding, acute kidney injury, and atrial fibrillation compared with a transcatheter approach. There was no statistical difference between the two approaches in terms of thromboembolic events, strokes, or transient ischemic attack rates. Surgical aortic valve replacement presents favorable 3-year survival rates compared with transcatheter aortic valve implantation.
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25
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Fioretta ES, Dijkman PE, Emmert MY, Hoerstrup SP. The future of heart valve replacement: recent developments and translational challenges for heart valve tissue engineering. J Tissue Eng Regen Med 2017; 12:e323-e335. [PMID: 27696730 DOI: 10.1002/term.2326] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/25/2016] [Accepted: 09/26/2016] [Indexed: 12/18/2022]
Abstract
Heart valve replacement is often the only solution for patients suffering from valvular heart disease. However, currently available valve replacements require either life-long anticoagulation or are associated with valve degeneration and calcification. Moreover, they are suboptimal for young patients, because they do not adapt to the somatic growth. Tissue-engineering has been proposed as a promising approach to fulfil the urgent need for heart valve replacements with regenerative and growth capacity. This review will start with an overview on the currently available valve substitutes and the techniques for heart valve replacement. The main focus will be on the evolution of and different approaches for heart valve tissue engineering, namely the in vitro, in vivo and in situ approaches. More specifically, several heart valve tissue-engineering studies will be discussed with regard to their shortcomings or successes and their possible suitability for novel minimally invasive implantation techniques. As in situ heart valve tissue engineering based on cell-free functionalized starter materials is considered to be a promising approach for clinical translation, this review will also analyse the techniques used to tune the inflammatory response and cell recruitment upon implantation in order to stir a favourable outcome: controlling the blood-material interface, regulating the cytokine release, and influencing cell adhesion and differentiation. In the last section, the authors provide their opinion about the future developments and the challenges towards clinical translation and adaptation of heart valve tissue engineering for valve replacement. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Emanuela S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland
| | - Petra E Dijkman
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland
| | - Maximilian Y Emmert
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland.,Heart Center Zurich, University Hospital Zurich, Switzerland.,Wyss Translational Center Zurich, Switzerland
| | - Simon P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland.,Wyss Translational Center Zurich, Switzerland.,Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands
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Capretti G, Urena M, Himbert D, Ghodbane W, Gardy Verdonk C, Goublaire C, Alkhoder S, Raffoul R, Carrasco J, Laredo M, Nataf P, Vahanian A. Suprasternal brachiocephalic approach as an alternative route for transcatheter aortic valve implantation: a single-centre experience. EUROINTERVENTION 2017; 12:e1849-e1856. [DOI: 10.4244/eij-d-16-00353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Petersen J, Vettorazzi E, Winter L, Schmied W, Kindermann I, Schäfers HJ. Physical and mental recovery after conventional aortic valve surgery. J Thorac Cardiovasc Surg 2016; 152:1549-1556.e2. [DOI: 10.1016/j.jtcvs.2016.07.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 06/29/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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28
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Thourani VH, Forcillo J. The Future of Transaortic Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:1823-4. [DOI: 10.1016/j.jcin.2016.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022]
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29
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Koster A, Ensminger S, Vlachojannis M, Birschmann I. Bivalirudin anticoagulation for minimal invasive transapical transcatheter aortic valve replacement in a patient with antiphospholipid antibodies. J Clin Anesth 2016; 33:373-5. [DOI: 10.1016/j.jclinane.2016.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
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30
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Sola M, Ramm CJ, Kolarczyk LM, Teeter EG, Yeung M, Caranasos TG, Vavalle JP. Application of a Multidisciplinary Enhanced Recovery After Surgery Pathway to Improve Patient Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2016; 118:418-23. [PMID: 27344271 DOI: 10.1016/j.amjcard.2016.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 12/18/2022]
Abstract
Enhanced recovery after surgery (ERAS) protocols have proven effective in a variety of surgical specialties. Published reports on these pathways within cardiac surgery and interventional cardiology are limited. Invasive aortic valve replacement procedures are increasingly being performed by hybrid groups of interventional cardiologists and surgeons through transcatheter aortic valve implantation (TAVI). The TAVI patient population is at a higher surgical risk compared with those undergoing surgical aortic valve replacement since they are older, frailer, and have significant co-morbidities which result in an increased risk of perioperative complications. ERAS protocols have the potential to help these patients undergoing TAVI procedures. In conclusion, we propose a TAVI ERAS protocol with a call-to-action for other centers to implement an ERAS protocol to improve hospital and cardiac outcomes.
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31
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Ferrari E, Muller O, Demertzis S, Moccetti M, Moccetti T, Pedrazzini G, Eeckhout E. Transaortic transcatheter aortic valve replacement through a right minithoracotomy with the balloon-expandable Sapien 3 valve. Multimed Man Cardiothorac Surg 2016; 2016:mmw011. [PMID: 27401072 DOI: 10.1093/mmcts/mmw011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/08/2016] [Indexed: 12/12/2022]
Abstract
Transaortic transcatheter aortic valve replacement performed through a right anterolateral minithoracotomy at the second intercostal space is a safe and standardized minimally invasive procedure carrying important clinical advantages for the patient, in particular, no damage to the ventricular apex, preservation of the diseased peripheral arteries and no cross of the aortic arch with the delivery system, meaning a lower risk of calcium dislodgement and neurological complications. Using the third-generation, balloon-expandable Edwards Sapien™ 3 transcatheter heart valve and the Certitude™ delivery system, the transaortic procedure is easily performed under fluoroscopic and echocardiographic guidance. Compared with the transapical procedure, the transaortic technique requires an inversely mounted stent valve and follows the standard guidelines for valve positioning and deployment under rapid pacing. The transaortic approach through a right anterolateral minithoracotomy at the second intercostal space combines the positive aspects of both transfemoral and transapical valve replacements without the risks of either procedure (left ventricular, coronary and peripheral vascular injuries).
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Affiliation(s)
- Enrico Ferrari
- The Heart-Team, Cardiocentro Ticino Foundation, Lugano, Switzerland The Heart-Team, University Hospital of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- The Heart-Team, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Marco Moccetti
- The Heart-Team, Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - Tiziano Moccetti
- The Heart-Team, Cardiocentro Ticino Foundation, Lugano, Switzerland
| | | | - Eric Eeckhout
- The Heart-Team, University Hospital of Lausanne, Lausanne, Switzerland
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Mosquera VX, Herrera-Noreña JM, Cuenca JJ. Implante transcatéter valvular aórtico: ¿cuál es el mejor acceso alternativo? CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ramakrishna H, Patel PA, Gutsche JT, Vallabhajosyula P, Spitz W, Feinman JW, Shah R, Zhou E, Weiss SJ, Augoustides JG. Transcatheter Aortic Valve Replacement: Clinical Update on Access Approaches in the Contemporary Era. J Cardiothorac Vasc Anesth 2016; 30:1425-9. [PMID: 27468895 DOI: 10.1053/j.jvca.2016.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, Arizona
| | | | | | - Prashanth Vallabhajosyula
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Ronak Shah
- Department of Anesthesiology and Critical Care
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Caruso D, Rosenberg RD, De Cecco CN, Mangold S, Wichmann JL, Varga-Szemes A, Steinberg DH, Laghi A, Schoepf UJ. Vascular Imaging Before Transcatheter Aortic Valve Replacement (TAVR): Why and How? Curr Cardiol Rep 2016; 18:14. [DOI: 10.1007/s11886-015-0694-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Dorval JF. Transcatheter Aortic Valve Implantation: Finding Its Path. Can J Cardiol 2015; 31:1415-7. [PMID: 26598220 DOI: 10.1016/j.cjca.2015.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Jean-François Dorval
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Québec, Canada.
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