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Rooijakkers MJP, Versteeg GAA, Hemelrijk KI, Aarts HM, Overduin DC, van Ginkel DJ, Vlaar PJ, van Wely MH, van Nunen LX, van Geuns RJ, van Garsse LAFM, Geuzebroek GSC, Verkroost MWA, Rodwell L, Heijmen RH, Tonino PAL, Ten Berg JM, Delewi R, van Royen N. Upper extremity versus lower extremity for secondary access during transcatheter aortic valve implantation: rationale and design of the randomised TAVI XS trial. Neth Heart J 2024:10.1007/s12471-024-01869-5. [PMID: 38653922 DOI: 10.1007/s12471-024-01869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND During transcatheter aortic valve implantation (TAVI), secondary access is required for angiographic guidance and temporary pacing. The most commonly used secondary access sites are the femoral artery (angiographic guidance) and the femoral vein (temporary pacing). An upper extremity approach using the radial artery and an upper arm vein instead of the lower extremity approach using the femoral artery and femoral vein may reduce clinically relevant secondary access site-related bleeding complications, but robust evidence is lacking. TRIAL DESIGN The TAVI XS trial is a multicentre, randomised, open-label clinical trial with blinded evaluation of endpoints. A total of 238 patients undergoing transfemoral TAVI will be included. The primary endpoint is the incidence of clinically relevant bleeding (i.e. Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding) of the randomised secondary access site (either diagnostic or pacemaker access, or both) within 30 days after TAVI. Secondary endpoints include time to mobilisation after TAVI, duration of hospitalisation, any BARC type 2, 3 or 5 bleeding, and early safety at 30 days according to Valve Academic Research Consortium‑3 criteria. CONCLUSION The TAVI XS trial is the first randomised trial comparing an upper extremity approach to a lower extremity approach with regard to clinically relevant secondary access site-related bleeding complications. The results of this trial will provide important insights into the safety and efficacy of an upper extremity approach in patients undergoing transfemoral TAVI.
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Affiliation(s)
- Maxim J P Rooijakkers
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Geert A A Versteeg
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kimberley I Hemelrijk
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Hugo M Aarts
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Daniël C Overduin
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Dirk-Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Pieter J Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Marleen H van Wely
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lokien X van Nunen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Robert Jan van Geuns
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Leen A F M van Garsse
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Guillaume S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michel W A Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura Rodwell
- Department of Health Sciences, Section Biostatistics, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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2
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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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3
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Yan Y, Yao J, Yuan F, Liu X, Luo T, Lu Z, Chang S, Zhang Q, Liu R, Yin C, Song G. Single femoral artery access is safe and feasible during transcatheter aortic valve replacement: a propensity score matched analysis. Front Cardiovasc Med 2023; 10:1228258. [PMID: 38028496 PMCID: PMC10655139 DOI: 10.3389/fcvm.2023.1228258] [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: 05/24/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) potentially may be significantly simplified by using the single artery access (SA) technique, which does not require a secondary artery access. Nevertheless, the safety and efficacy of this technique remains unclear. Our goal was to determine if single artery access TAVR (without upgrading the sheath size) is a feasible, minimally invasive procedure. Methods Patients with symptomatic severe aortic stenosis who underwent TAVR via the femoral artery were consecutively enrolled in this study. Eligible individuals were divided into 2 groups: the SA group and the dual artery access (DA) group. The primary end point was device success (defined by the valve academic research consortium 3, VARC 3). A 6-month follow-up and propensity score matching analyses were performed. Results After propensity score matching analysis, a total of 130 patients were included: 65 in the SA group and 65 in the DA group. The SA procedure achieved similar device success (95.4% vs. 87.7%; P = 0.115) compared with the DA procedure. The SA procedure shortened the operating time (102 min vs. 125 min; P = 0.001) but did not increase the x-ray time or dose. Both a 20 Fr and a 22 Fr sheath (without upgrading the sheath size) could be used for the SA procedure. There was no major vascular complication occurred in both groups. The incidence of minor main vascular and access complications in the SA group was comparable to those of the DA procedure (0.0% vs. 3.1%; P = 0.156). Conclusions The SA access procedure is a promising minimally invasive TAVR technique with a low incidence of vascular complications and a high incidence of device success. It is safe and possibly applicable in all TAVR procedures.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Guangyuan Song
- Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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4
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Edris A, Manla Y, Al Badarin F, Hasan K, Hashmani S, Traina M, Khiati D, Khalouf A, El Zouhbi A, Tuzcu EM. Outcomes of Transcatheter Aortic Valve Replacement in the United Arab Emirates: Real-world, Single-centre Experience from an Emerging Programme. Interv Cardiol 2023; 18:e08. [PMID: 37601733 PMCID: PMC10433106 DOI: 10.15420/icr.2022.04] [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: 02/01/2022] [Accepted: 05/01/2022] [Indexed: 03/15/2023] Open
Abstract
Background Data on outcomes of transcatheter aortic valve replacement (TAVR) in the Middle East, particularly in the United Arab Emirates (UAE), are limited. Whether centres with a low volume of patients requiring the procedure can achieve similar outcomes as those reported in pivotal clinical trials remains unclear. This study evaluates procedural outcomes of patients undergoing TAVR in a newly established programme in the UAE. Methods Procedural outcomes of consecutive patients who underwent transfemoral TAVR at a single centre in the UAE between January 2016 and November 2021 were compared with those at centres in the lowest quartile (Q1) of procedural volume in the Transcatheter Valve Therapy Registry, which covers centres in the US. Results Among the 183 patients included in the study, the median age was 76 years (interquartile range [IQR] 71-82), and 42.1% of patients were women, with a median Society of Thoracic Surgeons predicted risk of mortality score of 4.6 (IQR 2.9-7.5). Most of the patients (93.3%) received a balloon-expandable valve. All-cause death within 30 days, stroke and major vascular complications occurred in 0.6%, 0.6% and 2.2% of patients, respectively, compared with 3.1%, 2.2% and 4% in patients treated at Q1 hospitals. Conclusion Patients undergoing transfemoral TAVR at an emerging centre in the Middle East had favourable outcomes compared with those performed at Q1 hospitals in the US. These findings suggest that careful patient selection for TAVR is critical and may help optimise patient outcomes, especially when procedural volumes are low.
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Affiliation(s)
- Ahmad Edris
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Yosef Manla
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Firas Al Badarin
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Khwaja Hasan
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Shahrukh Hashmani
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Mahmoud Traina
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Dhiaedin Khiati
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Amani Khalouf
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Anas El Zouhbi
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
| | - Emin Murat Tuzcu
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi Abu Dhabi, United Arab Emirates
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5
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Leone PP, Scotti A, Ludwig S, Sehatbakhsh S, Assafin M, Chau M, Spring A, Montesino J, Doolittle J, Granada JF, Latib A. Predictable Deployment of Suture-Based Vascular Closure Device Before Transfemoral Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2023; 16:485-486. [PMID: 36669982 DOI: 10.1016/j.jcin.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Pier Pasquale Leone
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Sebastian Ludwig
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Samineh Sehatbakhsh
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Manaf Assafin
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mei Chau
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alexander Spring
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jesus Montesino
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - James Doolittle
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan F Granada
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
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Tagliari AP, Taramasso M. New Practices in Transcatheter Aortic Valve Implantation: How I Do It in 2023. J Clin Med 2023; 12:jcm12041342. [PMID: 36835878 PMCID: PMC9964275 DOI: 10.3390/jcm12041342] [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: 01/05/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) went through a huge evolution in the last decades. Previously performed under general anesthesia, with transoperative transesophageal echocardiography guidance and using cutdown femoral artery access, the procedure has now evolved into a minimalist approach, with local anesthesia, conscious sedation, and the avoidance of invasive lines becoming the new standards. Here, we discuss the minimalist TAVI approach and how we incorporate it into our current clinical practice.
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Affiliation(s)
- Ana Paula Tagliari
- Cardiovascular Surgery Department, Hospital São Lucas da PUC-RS, Porto Alegre 90619-900, Brazil
- Cardiovascular Surgery Department, Hospital Mãe de Deus, Porto Alegre 90880-0481, Brazil
- Correspondence: ; Tel.: +55-(51)-33205186
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich, Clinic of Cardiac Surgery, 8008 Zurich, Switzerland
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7
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Bagur R, Chu MWA, Ordoñez S, Valdis M, Gelinas J, Chaumont G, Teefy PJ, Diamantouros P. Single Access for Transfemoral Transcatheter Aortic Valve Implantation With the Acurate neo/neo 2 Self-Expanding Valve. Can J Cardiol 2023; 39:35-37. [PMID: 36328177 DOI: 10.1016/j.cjca.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Rodrigo Bagur
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Michael W A Chu
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Santiago Ordoñez
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Matthew Valdis
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Jill Gelinas
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Gloria Chaumont
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Patrick J Teefy
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Pantelis Diamantouros
- Heart Team, London Health Sciences Centre, Western University, London, Ontario, Canada
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8
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Helmy T, Mina G. Single access TAVR. How "minimalist" do we need to be? Catheter Cardiovasc Interv 2022; 100:233-234. [PMID: 35920372 DOI: 10.1002/ccd.30334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Tarek Helmy
- Division of Cardiology, Ochsner Louisiana State University Health, Shreveport, Louisiana, USA
| | - George Mina
- Division of Cardiology, Ochsner Louisiana State University Health, Shreveport, Louisiana, USA
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9
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Aroney NP, Patterson T, Kalogeropoulos A, Allen CJ, Hurrell H, Chehab O, Grapsa J, Rajani R, Prendergast B, Redwood S. Clinical outcomes following single access transfemoral transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2022; 100:227-232. [PMID: 35686532 DOI: 10.1002/ccd.30246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We describe the first experience using calcification of anatomical landmarks to obviate the need for transcatheter aortic valve implantation (TAVI) alignment aortography and secondary TAVI access. BACKGROUND TAVI alignment conventionally involves secondary femoral access for contrast aortography using a second catheter. Secondary femoral access accounts for up to 25% of all vascular complications. Heavily calcified aortic leaflets are often visible fluoroscopically and can act as markers for TAVI alignment. METHODS We considered 100 consecutive patients for transfemoral TAVI. The first group was considered for a conventional dual access technique and the subsequent group was considered for a single access technique. Relevant baseline, and procedural and outcome measures were recorded. RESULTS Baseline characteristics were comparable between groups. Balloon-expandable transcatheter heart valves (THV) were used in all cases. THV implantation was successful in 100% of cases with no procedural or in-hospital mortality. Procedural time and contrast use were lower in the single access group. There were no Valve Academic Research Consortium (VARC)-2 major vascular complications with the single access technique. CONCLUSIONS This is the first study describing the use of calcification of anatomical landmarks to obviate the need for secondary TAVI access. Notable observations included successful device implantation in all cases, no VARC-2 major vascular complications, comparable rates of paravalvular leak and permanent pacemaker requirement, shorter procedural times, and lower contrast use. Single access TAVI is a viable alternative technique to minimize vascular access, contrast use, and procedural duration in experienced centers and with selected patients, allowing successful device implantation and low complication rates while further streamlining TAVI workflow.
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Affiliation(s)
- Nicholas P Aroney
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tiffany Patterson
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Christopher J Allen
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Harriet Hurrell
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Omar Chehab
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Julia Grapsa
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ronak Rajani
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Bioengineering and Imaging Sciences, King's College London, London, UK
| | - Bernard Prendergast
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon Redwood
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
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10
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Gad MM, Elgendy IY, Saad AM, Mahmoud AN, Isogai T, Chahine J, Kadri AN, Ghanta R, Jimenez E, Kapadia SR, Jneid H. Outcomes of transcatheter versus surgical aortic valve replacement in patients <60 years of age. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:7-12. [DOI: 10.1016/j.carrev.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/06/2022] [Accepted: 05/09/2022] [Indexed: 12/30/2022]
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11
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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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12
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Sliman H, Eitan A, Shiran A, Zafrir B, Jaffe R. Transbrachial Secondary Vascular Access in Transcatheter Aortic Valve Replacement Procedures: A Single-Centre Retrospective Analysis. Heart Lung Circ 2022; 31:1023-1028. [PMID: 35277348 DOI: 10.1016/j.hlc.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/30/2021] [Accepted: 01/27/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Transfemoral transcatheter aortic valve replacement (TAVR) procedures require secondary vascular access for inserting accessory catheters and performing percutaneous repair of femoral artery injury. Use of the transbrachial approach for secondary vascular access in TAVR procedures has not been reported. METHODS This study identified 48 patients at the current institution who had undergone transfemoral TAVR utilising transbrachial secondary vascular access. Efficacy and safety of this strategy for achieving a successful totally percutaneous procedure were examined. Study endpoints were occurrence of vascular complications and bleeding related to transbrachial access, as well as periprocedural and 1-year mortality. RESULTS Mean patient age was 80±7 years and Society of Thoracic Surgeons Predicted Risk of Mortality score was 10.6±3.1. Sizes of sheaths inserted into the brachial artery were 6 Fr (85%), 8 Fr (2%), and 9 Fr (13%). Transbrachial access was used for delivering stent grafts to the femoral artery in 13% of the patients, inflation of an occlusive balloon within the iliac artery in 10%, and treatment of iatrogenic femoral artery stenosis in 2%. Successful valve replacement was achieved in all cases. Brachial sheaths were removed by manual compression following administration of protamine sulfate. There were no major access site complications or VARC-3 type ≥2 bleeding related to the brachial vascular access. Brachial artery occlusion occurred in two patients (4%) who underwent surgical vascular repair. Two (2) additional patients developed mild arm ischaemia, which was treated conservatively. Periprocedural mortality was 0% and early mortality was 8%. CONCLUSIONS Transbrachial secondary access in TAVR procedures was feasible and enabled percutaneous vascular repair in cases of femoral artery injury.
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Affiliation(s)
- Hussein Sliman
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Avinoam Shiran
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Barak Zafrir
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Ronen Jaffe
- Department of Cardiology, Carmel Medical Center, Haifa, Israel.
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13
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El Tahlawy W, Bader F, Traina MI, Edris A. Transcatheter aortic valve replacement in a patient with critical bicuspid aortic stenosis and cardiogenic shock: case report. Eur Heart J Case Rep 2022; 6:ytac101. [PMID: 35474677 PMCID: PMC9026192 DOI: 10.1093/ehjcr/ytac101] [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: 08/14/2021] [Revised: 09/03/2021] [Accepted: 01/19/2022] [Indexed: 11/28/2022]
Abstract
Background Cardiogenic shock (CS) is associated with significant morbidity and mortality (27–51%). Little is known about the feasibility and safety of emergency transcatheter aortic valve replacement (TAVR) for critical aortic stenosis (AS) in acute myocardial infarction (AMI) with CS. Case summary A 57-year-old male with history of tobacco dependence and diabetes mellitus presented with acute posterior ST-segment elevation myocardial infarction and CS. The patient initially underwent successful primary percutaneous intervention to an anomalous circumflex artery coming off the right cusp. It was noted to have advanced CS out of proportion to his coronary anatomy. Echocardiographic assessment noted critical AS. Heart team decided to perform percutaneous aortic balloon valvuloplasty under support of extracorporeal membrane oxygenation. Percutaneous aortic balloon valvuloplasty was performed and was complicated by severe aortic regurgitation (AR). A balloon-expandable transcatheter heart valve was then placed with resolution of AR and stabilization of the patient. Then, the patient was subsequently decannulated within a week then was able to go home after 47 days (32 days intensive care unit). His course was notable for a minor stroke due to initial period of hypotension and CS. He was extubated and remained hospitalized for several weeks participating in rehabilitation. Follow-up echo showed a well-seated and functioning transcatheter heart valve. His left ventricular systolic function improved from 21% to 45%. Conclusion Emergency TAVR is feasible and can be performed in a patient with AMI and CS. Early initiation of mechanical support allowed the patient to receive definitive treatment. The multidisciplinary heart team is essential and reflected in the ultimate outcome of our patient.
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Affiliation(s)
- Walid El Tahlawy
- Cardiology Department, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi , Swing Wing
- Level 8
- Room C 08-289, Al Maryah Island, PO BOX 112412 , Abu Dhabi, United Arab Emirates
| | - Feras Bader
- Cardiology Department, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi , Swing Wing
- Level 8
- Room C 08-289, Al Maryah Island, PO BOX 112412 , Abu Dhabi, United Arab Emirates
| | - Mahmoud Idris Traina
- Cardiology Department, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi , Swing Wing
- Level 8
- Room C 08-289, Al Maryah Island, PO BOX 112412 , Abu Dhabi, United Arab Emirates
| | - Ahmad Edris
- Cardiology Department, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi , Swing Wing
- Level 8
- Room C 08-289, Al Maryah Island, PO BOX 112412 , Abu Dhabi, United Arab Emirates
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14
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Reed GW, Puri R, Kumar A. Searching for closure after transfemoral TAVR. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 37:41-42. [DOI: 10.1016/j.carrev.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
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15
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Briguori C, Scarpelli M. The "locking and dragging" technique a facilitated crossover balloon occlusion technique for complex iliofemoral anatomy in transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2021; 98:E968-E970. [PMID: 34390113 DOI: 10.1002/ccd.29915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022]
Abstract
Crossover balloon occlusion technique (CBOT) has been proposed to ensure adequate closure of the arterial access used for transcatheter aortic valve replacement (TAVR). However, the CBOT performed through the contralateral femoral artery could be challenging in cases of excessively tortuous and calcified vessels or in the presence of narrow iliac carina angles. We describe a novel technique to facilitate the advancement the peripheral balloon through the contralateral femoral artery up to the target iliofemoral system in order to facilitate access site hemostasis. The present "locking and drugging" technique takes advantages from two mechanical aspects: (a) the locking of the 0.018″ wire between the vessel wall and the TAVR delivery system or the dedicated sheath, which facilitate the crossover of the balloon in the contralateral iliofemoral system, preventing its prolapse into the aorta at the carina level and (b) the dragging of the balloon advanced into the contralateral iliofemoral system during the retrieve of the TAVR delivery system or the dedicated sheath.
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Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Mario Scarpelli
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
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16
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Kim WK, Doerr O, Renker M, Choi YH, Liakopoulos O, Hamm CW, Nef H. Initial experience with a novel, modular, minimalistic approach for transfemoral aortic valve implantation. Int J Cardiol 2021; 332:54-59. [PMID: 33775796 DOI: 10.1016/j.ijcard.2021.03.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/27/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We introduce a novel approach that involves a single arterial access and low contrast agent volume (SLIM). BACKGROUND Transcatheter aortic valve implantation (TAVI) is subject to an ongoing process of refinement and simplification. METHODS Between January 2019 and November 2020, a total 888 patients with severe aortic stenosis underwent transfemoral TAVI using balloon-expandable or specific self-expanding devices. The study cohort comprised patients with attempted SLIM approach (n = 291). A matched cohort of patients who were treated in a standard fashion served as control group (n = 291). RESULTS The SLIM approach was successful in 92.4% of attempted cases. In the SLIM group, utilization of contrast agent (23 [19-37] vs. 75 [52-100] ml; p < 0.001), rates of any acute kidney injury (5.5% vs. 12.7%; p = 0.002), complications at the secondary access (0.3% vs. 3.1%; p = 0.011) and length of hospital stay (7 [5-8] vs. 7 [6-9]) days; p = 0.039) were significantly reduced. All other procedural outcomes were similar between groups. CONCLUSIONS Initial results of this novel, minimalistic approach demonstrate its feasibility and potential beneficial effects without compromising procedural safety. Further refinement of this approach is warranted.
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Affiliation(s)
- Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Germany.
| | - Oliver Doerr
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Germany
| | - Matthias Renker
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Germany
| | - Yeong-Hoon Choi
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Germany
| | - Oliver Liakopoulos
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Germany
| | - Christian W Hamm
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Germany
| | - Holger Nef
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Germany
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17
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Van Mieghem NM, Daemen J. Reflections on the Fate of Cerebral Embolic Protection Devices With TAVR: The REFLECT II Trial. JACC Cardiovasc Interv 2021; 14:528-530. [PMID: 33663780 DOI: 10.1016/j.jcin.2020.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
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18
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Nagaraja V, Krishnaswamy A, Yun J, Kapadia SR. Same-Day Discharge After Transcatheter Native Aortic and Mitral Valve-in-Valve Replacement. JACC Case Rep 2020; 2:2199-2201. [PMID: 34317138 PMCID: PMC8299845 DOI: 10.1016/j.jaccas.2020.09.036] [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: 07/28/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
Transcatheter aortic valve replacement has become the gold standard of care in the management of patients with severe aortic stenosis and transcatheter mitral valve-in-valve replacement seems to be an attractive alternative to redo surgery. We report the first case of concomitant transcatheter aortic valve replacement/transcatheter mitral valve-in-valve replacement that was performed under conscious sedation who was subsequently discharged the same day. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Vinayak Nagaraja
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- Address for correspondence: Dr. Samir R. Kapadia, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195.
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19
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Reply: The Spotlight Is on Secondary Access for TAVR: Radial Versus Femoral Revisited. JACC Cardiovasc Interv 2020; 13:655-656. [PMID: 32139225 DOI: 10.1016/j.jcin.2020.01.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 12/15/2022]
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20
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Félix-Oliveira A, Campante Teles R, Mesquita Gabriel H, de Araújo Gonçalves P, de Sousa Almeida M. The Spotlight Is on Secondary Access for TAVR: Radial Versus Femoral Revisited. JACC Cardiovasc Interv 2020; 13:655. [PMID: 32139224 DOI: 10.1016/j.jcin.2019.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
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21
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Salas de Armas IA, Basra SS, Patel MK, Akay MH, Kumar S, Carrazo W, Marcano J, Akkanti B, Patel J, Mittal K, de Filippis A, Zaki J, Gregoric ID, Kar B. Axillary Access TAVR: Entrapment of a Transcatheter Aortic Valve in the Innominate Artery With Aortic Dissection. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:43-46. [PMID: 32593599 DOI: 10.1016/j.carrev.2020.06.020] [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: 03/27/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
Non-femoral transcatheter aortic valve replacement (TAVR) is indicated when peripheral vascular disease is diagnosed. We describe the "double-stick" technique via the axillary artery. During the procedure, the pigtail coiled around the TAVR system. While retracting the TAVR sheath, the seam along system split dislodging the valve from the balloon. The valve was entrapped in the innominate artery, and an aortic dissection required surgery. With the double-stick technique, friction and resistance between the pigtail and delivery system must be avoided. Pre-procedural planning and early identification is paramount. Smaller and more seamless delivery systems may reduce risk for dissection and entrapment.
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Affiliation(s)
- Ismael A Salas de Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Sukhdeep S Basra
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Manish K Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - M Hakan Akay
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Wendy Carrazo
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Juan Marcano
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States of America
| | - Bindu Akkanti
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Jayeshkumar Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Kriti Mittal
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Alejandro de Filippis
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - John Zaki
- Department of Anesthesia, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, Houston, TX 77030, United States of America
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America.
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22
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Vascular Access Site for TAVR: Use the Approach You Master Best. JACC Cardiovasc Interv 2020; 13:1469-1470. [PMID: 32553336 DOI: 10.1016/j.jcin.2020.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/20/2022]
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23
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Unilateral Femoral Access for Transfemoral Approach in Transcatheter Aortic Valve Replacement: The Happy Medium? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:486-488. [PMID: 32563526 DOI: 10.1016/j.carrev.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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24
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Cormican D, McHugh S, Boisen M, Winter D, So CY, Villablanca PA, Ramakrishna H. The Low Risk Transcatheter Aortic Valve Replacement Trials-An Analysis. J Cardiothorac Vasc Anesth 2020; 34:3133-3138. [PMID: 32144060 DOI: 10.1053/j.jvca.2020.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel Cormican
- Department of Anesthesiology, Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Stephen McHugh
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Shadyside, Pittsburgh, PA
| | - Michael Boisen
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA
| | - Daniel Winter
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Northwestern Medicine, Chicago, IL
| | - Chak-Yu So
- Department of Cardiology, Henry Ford Hospital, Detroit, MI; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR
| | | | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MI.
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25
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Harrison JK. To Double Stick or Not to Double Stick? JACC Cardiovasc Interv 2019; 12:2221-2222. [PMID: 31699380 DOI: 10.1016/j.jcin.2019.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 11/28/2022]
Affiliation(s)
- J Kevin Harrison
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
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