1
|
Abusnina W, Machanahalli Balakrishna A, Ismayl M, Latif A, Reda Mostafa M, Al-abdouh A, Junaid Ahsan M, Radaideh Q, Haddad TM, Goldsweig AM, Ben-Dor I, Mamas MA, Dahal K. Comparison of Transfemoral versus Transsubclavian/Transaxillary access for transcatheter aortic valve replacement: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2022; 43:101156. [PMCID: PMC9718962 DOI: 10.1016/j.ijcha.2022.101156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Safe alternative access, that represents about 15 % of TAVR cases, remains important for patients without adequate transfemoral access. We aimed to perform a systematic review and meta-analysis of studies comparing transfemoral (TF) access versus transsubclavian or transaxillary (TSc/TAx) access in patients undergoing TAVR. We searched PubMed, Cochrane CENTRAL Register, EMBASE, Web of Science, Google Scholar and ClinicalTrials.gov (inception through May 24, 2022) for studies comparing (TF) to (TSc/TAx) access for TAVR. A total of 21 studies with 75,995 unique patients who underwent TAVR (73,203 transfemoral and 2,792 TSc/TAx) were included in the analysis. There was no difference in the risk of in-hospital and 30-day all-cause mortality between the two groups (RR 0.64, 95 % CI 0.36–1.13, P = 0.12) and (RR 0.95, 95 % CI 0.64–1.41, P = 0.81), while 1-year mortality was significantly lower in the TF TAVR group (RR 0.79, 95 % CI 0.67–0.93, P = 0.005). No significant differences in major bleeding (RR 0.82, 95 % CI 0.65–1.03, P = 0.09), major vascular complications (RR 1.14, 95 % CI 0.75–1.72, P = 0.53), and stroke (RR 0.66, 95 % CI 0.42–1.02, P = 0.06) were observed. In patients undergoing TAVR, TF access is associated with significantly lower 1-year mortality compared to TSc/TAx access without differences in major bleeding, major vascular complications and stroke. While TF is the preferred approach for TAVR, TSc/TAx is a safe alternative approach. Future studies should confirm these findings, preferably in a randomized setting.
Collapse
Key Words
- tavr
- tavi
- access site
- subclavian access
- axillary access
- femoral access
- aki, acute kidney injury
- as, aortic stenosis
- ci, confidence interval
- mi, myocardial infarction
- rr, risk ratio
- tavr, transcatheter aortic valve replacement
- tf, transfemoral
- tsc, transsubclavian
- tax, transaxillary
- tc, transcarotid
Collapse
Affiliation(s)
- Waiel Abusnina
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | | | - Mahmoud Ismayl
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Azka Latif
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | | | - Ahmad Al-abdouh
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Qais Radaideh
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Toufik M. Haddad
- Division of Cardiology, Creighton University School of Medicine, NE, USA
| | - Andrew M. Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, UK
| | - Khagendra Dahal
- Division of Cardiology, Creighton University School of Medicine, NE, USA,Corresponding author
| |
Collapse
|
2
|
The Transaxillary Route as a Second Access Option in TAVI Procedures: Experience of a Single Centre. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148649. [PMID: 35886501 PMCID: PMC9323695 DOI: 10.3390/ijerph19148649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023]
Abstract
Background: The aim of our study was to determine the feasibility and efficacy of transaxillary (TAX) TAVI in patients not eligible for the transfemoral route. Methods: This is a retrospective study of a single center. We analysed 262 patients treated with TAVI. In 17 patients (6.5%), the procedure was performed with the TAX approach. Procedural and hospital data, 30-day safety, and clinical efficacy were assessed and compared between the transfemoral and TAX groups. Results: In the TAX groups, we found a higher prevalence of men (p = 0.001), smokers (p = 0.033), and previous strokes (p = 0.02). The EUROSCORE II was higher in the TAX group (p = 0.014). The success rate of the device was 100%. TAX was associated with a longer procedure time (p = 0.001) and shorter median device time (p = 0.034) in minutes. Patients treated with TAX had a longer hospital stay (p = 0.005) and higher overall bleeding rate (p = 0.001). Peripheral neurological complications were more frequent with TAX (p = 0.001), which almost completely resolved by 30 days. Conclusions: TAX TAVI is safe and effective and should be considered as a second choice when transfemoral TAVI is not feasible due to severe comorbidities.
Collapse
|
3
|
Dietrich L, Kibler M, Matsushita K, Marchandot B, Trimaille A, Reydel A, Diop B, Truong PD, Trung AM, Trinh A, Carmona A, Hess S, Jesel L, Ohlmann P, Morel O. Impact of Primary Hemostasis Disorders on Late Major Bleeding Events among Anticoagulated Atrial Fibrillation Patients Treated by TAVR. J Clin Med 2021; 11:212. [PMID: 35011952 PMCID: PMC8746148 DOI: 10.3390/jcm11010212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Bleeding events are among the striking complications following transcatheter aortic valve replacement (TAVR), and bleeding prediction models are crucially warranted. Several studies have highlighted that primary hemostasis disorders secondary to persistent loss of high-molecular-weight (HMW) multimers of the von Willebrand factor (vWF) and assessed by adenosine diphosphate closure time (CT-ADP) may be a strong predictor of late major/life-threatening bleeding complications (MLBCs). Pre-existing atrial fibrillation (AF) is a frequent comorbidity in TAVR patients and potentially associated with increased bleeding events after the procedure. OBJECTIVES This study evaluated the impact of ongoing primary hemostasis disorders, as assessed by post-procedural CT-ADP > 180 s, on clinical events after TAVR among anticoagulated AF patients. METHODS An ongoing primary hemostasis disorder was defined by post-procedure CT-ADP > 180 s. Bleeding complications were assessed according to the Valve Academic Research Consortium-2 (VARC-2) criteria. The primary endpoint was the occurrence of late MLBCs at one-year follow-up. The secondary endpoint was a composite of mortality, stroke, myocardial infarction, and rehospitalization for heart failure. RESULTS In total, 384 TAVR patients were included in the analysis. Of these patients, 57 patients (14.8%) had a prolongated CT-ADP > 180 s. Increased MLBCs were observed in patients with CT-ADP > 180 s (35.1% versus 1.2%; p < 0.0001). Conversely, the occurrence of the composite endpoint did not differ between the groups. Multivariate analysis identified CT-ADP > 180 s (HR 28.93; 95% CI 9.74-85.95; p < 0.0001), bleeding history, paradoxical aortic stenosis (AS), and major vascular complications following TAVR as independent predictors of late MLBCs. CONCLUSION Among patients with anticoagulated AF, a post-procedural CT-ADP > 180 s was identified as a strong independent predictor of late MLBCs. These findings suggest that persistent primary hemostasis disorders contribute to a higher risk of late bleeding events and should be considered for a tailored, risk-adjusted antithrombotic therapy after TAVR.
Collapse
Affiliation(s)
- Laurent Dietrich
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
| | - Marion Kibler
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
| | - Kensuke Matsushita
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
- Institut National de la Santé et de la Recherche Médicale (INSERM), Nano Médecine Régénérative, Unité Mixte de Recherche 1260, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France
| | - Benjamin Marchandot
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
| | - Antonin Trimaille
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
| | - Antje Reydel
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
| | - Bamba Diop
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
| | - Phi Dinh Truong
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi 100000, Vietnam; (P.D.T.); (A.M.T.)
| | - Anh Mai Trung
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi 100000, Vietnam; (P.D.T.); (A.M.T.)
| | - Annie Trinh
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
| | - Adrien Carmona
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
| | - Sébastien Hess
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
| | - Laurence Jesel
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
- Institut National de la Santé et de la Recherche Médicale (INSERM), Nano Médecine Régénérative, Unité Mixte de Recherche 1260, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France
| | - Patrick Ohlmann
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
| | - Olivier Morel
- Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
- Institut National de la Santé et de la Recherche Médicale (INSERM), Nano Médecine Régénérative, Unité Mixte de Recherche 1260, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France
| |
Collapse
|
4
|
Faroux L, Junquera L, Mohammadi S, Del Val D, Muntané-Carol G, Alperi A, Kalavrouziotis D, Dumont E, Paradis JM, Delarochellière R, Rodés-Cabau J. Femoral Versus Nonfemoral Subclavian/Carotid Arterial Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e017460. [PMID: 32990146 PMCID: PMC7792420 DOI: 10.1161/jaha.120.017460] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Some concerns remain regarding the safety of transcarotid and transsubclavian approaches for transcatheter aortic valve replacement. We aimed to compare the risk of 30‐day complications and death in transcarotid/transsubclavian versus transfemoral transcatheter aortic valve replacement recipients. Methods and Results Data from 20 studies, including 79 426 patients (16 studies) and 3992 patients (4 studies) for the evaluation of the unadjusted and adjusted impact of the arterial approach were sourced, respectively. The use of a transcarotid/transsubclavian approach was associated with an increased risk of stroke when using unadjusted data (risk ratio [RR], 2.28; 95% CI, 1.90–2.72) as well as adjusted data (odds ratio [OR], 1.53; 95% CI, 1.05–2.22). The pooled results deriving from unadjusted data showed an increased risk of 30‐day death (RR, 1.46; 95% CI, 1.22–1.74) and bleeding (RR, 1.53; 95% CI, 1.18–1.97) in patients receiving transcatheter aortic valve replacement through a transcarotid/transsubclavian access (compared with the transfemoral group), but the associations between the arterial access and death (OR, 1.22; 95% CI, 0.89–1.69), bleeding (OR, 1.05; 95% CI, 0.68–1.61) were no longer significant when using adjusted data. No significant effect of the arterial access on vascular complication was observed in unadjusted (RR, 0.84; 95% CI, 0.66–1.06) and adjusted (OR, 0.79; 95% CI, 0.53–1.17) analyses. Conclusions Transcarotid and transsubclavian approaches for transcatheter aortic valve replacement were associated with an increased risk of stroke compared with the transfemoral approach. However, these nonfemoral arterial alternative accesses were not associated with an increased risk of 30‐day death, bleeding, or vascular complication when taking into account the confounding factors.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - Lucia Junquera
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - David Del Val
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | - Alberto Alperi
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | - Eric Dumont
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| |
Collapse
|
5
|
Bruschi G, Colombo P, Botta L, Nava S, Merlanti B, Belli O, Musca F, Soriano F, Russo CF, Oliva F. Portico Sheathless Transcatheter Aortic Valve Implantation via Distal Axillary Artery. Ann Thorac Surg 2017; 103:e175-e177. [PMID: 28109383 DOI: 10.1016/j.athoracsur.2016.07.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 07/15/2016] [Accepted: 07/20/2016] [Indexed: 10/20/2022]
Abstract
Transcatheter aortic valve implantation has been designed to treat older patients affected by severe aortic stenosis who are considered high-risk surgical candidates because of multiple comorbidities. The least invasive approach for transcatheter aortic valves implantation should be considered the transfemoral retrograde route, because it is minimally invasive and is feasible with local anesthesia and mild sedation. Despite significant technical improvements in recent years, the transfemoral approach is contraindicated in cases of severe peripheral artery disease. We describe the first case of a Portico transcatheter aortic valve implantation system (St. Jude Medical, Minneapolis, MN) made through the distal axillary artery in a 90-year-old patient affected by severe aortic stenosis.
Collapse
Affiliation(s)
- Giuseppe Bruschi
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy.
| | - Paola Colombo
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy
| | - Luca Botta
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy
| | - Stefano Nava
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy
| | - Bruno Merlanti
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy
| | - Oriana Belli
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy
| | - Francesco Musca
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy
| | - Francesco Soriano
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy
| | - Claudio F Russo
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy
| | - Fabrizio Oliva
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Milan, Italy
| |
Collapse
|
6
|
Bruschi G, Colombo P, Merlanti B, Nava S, Belli O, Musca F, Soriano F, Botta L, Calini A, De Caria DF, Oliva F, Russo CF. A new access for transcatheter aortic valve implantation: Distal axillary artery. Int J Cardiol 2016; 223:810-812. [PMID: 27575782 DOI: 10.1016/j.ijcard.2016.08.290] [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: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Giuseppe Bruschi
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy.
| | - Paola Colombo
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Bruno Merlanti
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Stefano Nava
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Oriana Belli
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Francesco Musca
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | | | - Luca Botta
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Angelo Calini
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | | | - Fabrizio Oliva
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| | - Claudio F Russo
- "De Gasperis" Cardiac Center, ASST Niguarda General Hospital, Italy
| |
Collapse
|
7
|
Ozturk C, Iyisoy A, Sahin MA, Tavlasoglu M, Celik T, Balta S, Bozlar U, Guler A. Left subclavian artery dissection and repair after transcatheter aortic valve implantation; the diameter of the axillary artery is important for axillary intervention. Int J Cardiol 2016; 204:77-80. [PMID: 26655544 DOI: 10.1016/j.ijcard.2015.11.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Cengiz Ozturk
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey.
| | - Atila Iyisoy
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey
| | - Mehmet Ali Sahin
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiovascular Surgery, Etlik, Ankara, Turkey
| | - Murat Tavlasoglu
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiovascular Surgery, Etlik, Ankara, Turkey
| | - Turgay Celik
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey
| | - Sevket Balta
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey
| | - Ugur Bozlar
- Gulhane Military Medical Academy, School of Medicine, Department of Radiology, Etlik, Ankara, Turkey
| | - Adem Guler
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiovascular Surgery, Etlik, Ankara, Turkey
| |
Collapse
|
8
|
Abstract
The advent of transcatheter aortic valve replacement (TAVR) has modified the treatment of severe aortic stenosis (AS). Large randomized trials and multicenter registries have endorsed the efficacy of TAVR in improving outcomes in patients with severe AS who are inoperable or high surgical risk. There has been a noticeable shift in using TAVR in patients with AS who are not at a high surgical risk. Appropriate diagnosis, patient selection, and referral remain cornerstones to achieving optimal outcomes after TAVR or SAVR (surgical aortic valve replacement).
Collapse
Affiliation(s)
- Kunal Sarkar
- Department of Cardiology, Policlinico Tor Vergata, University of Rome, Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
| | - Mrinalini Sarkar
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Gian Paolo Ussia
- Department of Cardiology, Policlinico Tor Vergata, University of Rome, Tor Vergata, Viale Oxford 81, Rome 00133, Italy
| |
Collapse
|