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Moccetti F, Wolfrum M, Bossard M, Attinger-Toller A, Loretz L, Cuculi F, Toggweiler S. Transfemoral-only transcatheter aortic valve replacement: A single center experience of 400 consecutive patients. Catheter Cardiovasc Interv 2024. [PMID: 38736247 DOI: 10.1002/ccd.31077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND In transcatheter aortic valve replacement (TAVR), transfemoral (TF) access offers several advantages over alternative access routes. Advances in sheaths and valve delivery technology have catalyzed the feasibility of TF-TAVR, even in challenging anatomies. AIMS Report procedural characteristics and outcomes of a TAVR program aiming for a 100% TF access rate. METHODS Consecutive patients undergoing TAVR were enrolled in a prospective registry. Equipment used to facilitate TF-access in challenging anatomies included low-profile sheaths, dilatators, peripheral balloons, covered and uncovered self-expanding and balloon-expandable stents, and intravascular lithotripsy (IVL). RESULTS A total of 400 patients with a mean age of 81 ± 6 years (42% female) were analyzed. Minimal iliofemoral artery diameter (MLD) of the main access side was <5 mm in 42 (10.5%), extreme tortuosity was present in 65 (16.3%), and severe calcification in 59 (14.8%). TF-access was successful in 399 (99.8%) patients. A transaxillary access was used in one patient. In multivariable analysis, an MLD < 5 mm was the strongest predictor for vascular complications (11.9% vs. 3.9%, OR: 3.86, 95% CI: 1.38-10.8, p = 0.01). Such patients also had more major/life-threatening bleeding (14.2% vs. 3.1%, p < 0.001) and required more planned and unplanned peripheral interventions to enable TF access (35.8% vs. 3.4%, p < 0.001). CONCLUSION Our study shows that utilization of dedicated sheaths, peripheral balloons, stents, and IVL enables TAVR via TF access in >99% of patients. However, rates of vascular and bleeding complications in patients with narrow iliofemoral arteries (MLD < 5 mm) were high.
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Affiliation(s)
- Federico Moccetti
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Bossard
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Lucca Loretz
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Heart Center Lucerne, Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
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Buonpane A, Trimarchi G, Palmieri C, Jabri AAAA, Berti S, Rizza A. Kissing shockwave balloon in a case of extensive calcified abdominal aorta during transfemoral TAVI. Curr Probl Cardiol 2024; 49:102491. [PMID: 38428553 DOI: 10.1016/j.cpcardiol.2024.102491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/03/2024]
Abstract
An 84-year-old man with extensive calcified atherosclerosis of the infrarenal abdominal aorta was diagnosed with severe aortic valve stenosis, presenting with dyspnea. To facilitate transfemoral approach during the TAVI procedure, IVUS-guided intravascular lithotripsy was successfully performed using Kissing Shockwave Balloon Technique.
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Affiliation(s)
- Angela Buonpane
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Giancarlo Trimarchi
- Departement of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Cataldo Palmieri
- Cardiology Unit, Ospedale del Cuore, Fondazione Toscana "G. Monasterio", 54100 Massa, Italy
| | | | - Sergio Berti
- Cardiology Unit, Ospedale del Cuore, Fondazione Toscana "G. Monasterio", 54100 Massa, Italy
| | - Antonio Rizza
- Cardiology Unit, Ospedale del Cuore, Fondazione Toscana "G. Monasterio", 54100 Massa, Italy
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3
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Fazzini S, Pennetta FF, Torsello G, Turriziani V, Vona S, Ascoli Marchetti A, Ippoliti A, Austermann M, Bosiers MJ. Intravascular Iliac Artery Lithotripsy to Facilitate Aortic Endograft Delivery: Midterm Results of a Dual-Center Experience. J Endovasc Ther 2024:15266028241241246. [PMID: 38561973 DOI: 10.1177/15266028241241246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE To assess the feasibility and safety of intravascular lithotripsy (IVL) for enabling transfemoral abdominal (EVAR), thoracic (TEVAR), and thoracoabdominal (BEVAR) endovascular aneurysm repair in patients with narrow and calcified iliac arteries. MATERIALS AND METHODS Consecutive patients treated with IVL for severe calcified and narrowed iliac access before EVAR, TEVAR, or BEVAR between November 2020 and June 2022 were retrospectively evaluated. All anatomical iliac characteristics were acquired by multi-planar reconstruction of preoperative computed tomography angiography (CTA). The hostility of the vascular accesses was classified based on Peripheral Arterial Calcium Scoring System (PACSS) and calcified access severity score (CASS), a new score considering both anatomical (calcium grade and length, minimum lumen diameter [MLD], and tortuosity index) and aortic stent-graft (SG/MLD index) parameters. Primary endpoint was technical success defined as successful aortic endograft delivery and deployment without iliac rupture. Freedom from complications and primary patency were additionally analyzed. RESULTS Twenty-eight iliac axes were treated with IVL (8 bilateral) in 20 patients (mean age 74.5±6.7 years) with a mean follow-up of 26.5±6.2 (range 17-36) months. Ten patients underwent EVAR: 3 TEVAR, and 7 BEVAR procedures. In 14 patients (70%), aneurysm disease was associated with symptomatic aorto-iliac occlusive disease (AIOD), with Rutherford class III to IV. The PACSS was grade IV in 89% of the cases and the CASS (mean 14±2) was grade III to IV in all cases. The stent-graft (SG) outer diameter (5.60±1.65 mm) was significantly larger by 50% than MLD (3.96±1.20 mm), with an SG/MLD index of 1.50±0.51 (p<0.001). Technical success was 100%. No dissection, rupture, or distal embolization occurred. One (3.4%) bail-out stenting was necessary as endoconduit after IVL treatment. One month CTA showed that postoperative luminal gain increased by 93% (p<0.001). An improvement of 2 Rutherford classes occurred in all AIOD patients with a primary patency of 100% at last follow-up. CONCLUSIONS This study shows the safety and feasibility of IVL as a valuable option to treat narrow and calcified iliac arteries to facilitate endograft delivery. Further studies will be useful to confirm these results. CLINICAL IMPACT In this article, the use of intravascular iliac artery lithotripsy to facilitate aortic endograft delivery is explored. The presence of iliac severe calcifications still represents a contraindication for aortic endovascular repair. Intravascular lithotripsy increases the feasibility and safety of endovascular aortic procedures, facilitating endograft delivery and reducing the risk of iliac rupture and/or dissections by improving vessel compliance and luminal gain. This novel vessel preparation could be an alternative to "paving and cracking" and/or iliac conduits. This study describes a new score to classify the severity of iliac calcifications, considering anatomical parameters and the profile of aortic endografts delivery system.
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Affiliation(s)
- Stefano Fazzini
- Vascular and Endovascular Surgery, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Federico Francisco Pennetta
- Vascular and Endovascular Surgery, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Giovanni Torsello
- Institute for Vascular Research, St. Franziskus-Hospital, Münster, Germany
| | - Valerio Turriziani
- Vascular and Endovascular Surgery, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Simona Vona
- Vascular and Endovascular Surgery, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Andrea Ascoli Marchetti
- Vascular and Endovascular Surgery, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Arnaldo Ippoliti
- Vascular and Endovascular Surgery, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Martin Austermann
- Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany
| | - Michel Joseph Bosiers
- Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany
- Department of Vascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
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4
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Messas E, Ijsselmuiden A, Trifunović-Zamaklar D, Cholley B, Puymirat E, Halim J, Karan R, van Gameren M, Terzić D, Milićević V, Tanter M, Pernot M, Goudot G. Treatment of severe symptomatic aortic valve stenosis using non-invasive ultrasound therapy: a cohort study. Lancet 2023; 402:2317-2325. [PMID: 37972628 DOI: 10.1016/s0140-6736(23)01518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Calcific aortic stenosis is commonly treated using surgical or transcatheter aortic valve replacement; however, many patients are not considered suitable candidates for these interventions due to severe comorbidities and limited life expectancy. As such, non-invasive therapies might offer alternative therapeutic possibilities in these patients. This study aimed to assess the safety of non-invasive ultrasound therapy and its ability to improve valvular function by softening calcified valve tissue. METHODS This prospective, multicentre, single-arm series enrolled 40 adult patients with severe symptomatic aortic valve stenosis at three hospitals in France, the Netherlands, and Serbia between March 13, 2019, and May 8, 2022. Patients were treated with transthoracically delivered non-invasive ultrasound therapy. Follow-ups were scheduled at 1, 3, 6, 12, and 24 months. The primary endpoints were procedure-related deaths within 30 days and improved valve function. We report the 6-month data. This study is registered at ClinicalTrials.gov, NCT03779620 and NCT04665596. FINDINGS 40 high-risk patients with a mean Society of Thoracic Surgeons score of 5·6% (SD 4·4) and multiple severe comorbidities were included. The primary endpoint, procedure-related mortality, did not occur; furthermore, no life-threatening or cerebrovascular events were reported. Improved valve function was confirmed up to 6 months, reflected by a 10% increase in mean aortic valve area from 0·58 cm2 (SD 0·19) at baseline to 0·64 cm2 (0·21) at follow-up (p=0·0088), and a 7% decrease in mean pressure gradient from 41·9 mm Hg (20·1) to 38·8 mm Hg (17·8; p=0·024). At 6 months, the New York Heart Association score had improved or stabilised in 24 (96%) of 25 patients, and the mean Kansas City Cardiomyopathy Questionnaire score had improved by 33%, from 48·5 (SD 22·6) to 64·5 (21·0). One serious procedure-related adverse event occurred in a patient who presented with a transient decrease in peripheral oxygen saturation. Non-serious adverse events included pain, discomfort during treatment, and transient arrhythmias. INTERPRETATION This novel, non-invasive ultrasound therapy for calcified aortic stenosis proved to be safe and feasible. FUNDING Cardiawave.
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Affiliation(s)
- Emmanuel Messas
- Cardiovascular Department, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France; Paris Cardiovascular Research Center, Inserm UMR_U970, Université Paris-Cité, Paris, France; STOP-AS Research Consortium, Recherche Hospitalo-Universitaire, Rouen, France.
| | | | - Danijela Trifunović-Zamaklar
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France; Innovative Therapies in Haemostasis, Inserm UMR_S1140, Université Paris-Cité, Paris, France
| | - Etienne Puymirat
- Cardiovascular Department, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France; Paris Cardiovascular Research Center, Inserm UMR_U970, Université Paris-Cité, Paris, France
| | - Jonathan Halim
- Cardiology Department, Amphia Hospital, Breda, Netherlands
| | - Radmila Karan
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Anaesthesiology and Intensive Care at Clinic for Cardiac Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Duško Terzić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Cardiac Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Vladimir Milićević
- Clinic for Cardiac Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Mickael Tanter
- Physics for Medicine Paris, Inserm/ESPCI Paris-PSL/CRNS, Paris, France
| | - Mathieu Pernot
- Physics for Medicine Paris, Inserm/ESPCI Paris-PSL/CRNS, Paris, France
| | - Guillaume Goudot
- Cardiovascular Department, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France
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5
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Ponna PK, Gonuguntla A, Botta RK, Fischell T, Agrawal Y. Shockwave Lithotripsy of Calcific Stenosis of the Distal Abdominal Aorta to Facilitate Transcatheter Aortic Valve Replacement. Cardiovasc Revasc Med 2023; 53S:S134-S138. [PMID: 37198066 DOI: 10.1016/j.carrev.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
The transfemoral approach for transcatheter aortic valve replacement (TAVR) is superior to alternative access strategies. Only transfemoral access has been shown to have better clinical outcomes than surgical aortic valve replacement. In our patient, severe calcification of the distal abdominal aorta posed difficulty in using transfemoral access for TAVR. We applied intravascular lithotripsy (IVL) to the distal abdominal aorta to achieve necessary luminal gain facilitating bioprosthetic aortic valve deployment.
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Affiliation(s)
| | | | - Ramya Krishna Botta
- Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Tim Fischell
- Michigan State University, United States of America
| | - Yashwant Agrawal
- Banner Desert Medical Center, Mesa, AZ, United States of America
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6
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Mody R, Dash D, Mody B, Maligireddy AR, Agrawal A, Rastogi L, Monga IS. Can Most Calcified Coronary Stenosis Be Optimized With Coronary Intravascular Lithotripsy? JACC Asia 2023; 3:185-197. [PMID: 37181385 PMCID: PMC10167520 DOI: 10.1016/j.jacasi.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/08/2022] [Accepted: 11/29/2022] [Indexed: 05/16/2023]
Abstract
Intravascular lithotripsy can be used as an effective therapy for lesion preparation in severely calcified lesions. The mechanism, as shown by optical coherence tomography, is calcium fractures. The aforementioned modification is performed with minimal risk of perforation, no-reflow and a low incidence of flow-limiting dissection and myocardial infarctions. Other techniques, such as cutting or scoring balloons and rotational atherectomy have also been shown to increase luminal diameter, but other complications, such as distal embolization, induced by these treatment modalities, are a source of concern. This review describes a single-center study of all-comer patients, including those with complex characteristics. This therapy is very effective, with a very low risk of complications. In this article, we characterize the mechanism of action of the intravascular lithotripsy catheter, its optical coherence tomography validation, clinical applications, and comparison with other calcium-modifying technologies, as well as future directions, which can be used to improve the technology.
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Affiliation(s)
- Rohit Mody
- Department of Cardiology, Max Super Specialty Hospital, Bathinda, Punjab, India
| | - Debabrata Dash
- Department of Cardiology, Aster Hospital, Mankhool, Dubai, Al Quasis, UAE
| | - Bhavya Mody
- Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
| | | | - Ankit Agrawal
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lakshay Rastogi
- Department of Cardiology, Kasturba Medical College, Manipal, India
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Curini L, Pesce M. Shockwaves delivery for aortic valve therapy-Realistic perspective for clinical translation? Front Cardiovasc Med 2023; 10:1160833. [PMID: 37113704 PMCID: PMC10128859 DOI: 10.3389/fcvm.2023.1160833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
Calcific aortic valve disease (CAVD) is the most frequent valvular heart disorder, and the one with the highest impact and burden in the elderly population. While the quality and standardization of the current aortic valve replacements has reached unprecedented levels with the commercialization of minimally-invasive implants and the design of procedures for valve repair, the need of supplementary therapies able to block or retard the course of the pathology before patients need the intervention is still awaited. In this contribution, we will discuss the emerging opportunity to set up devices to mechanically rupture the calcium deposits accumulating in the aortic valve and restore, at least in part, the pliability and the mechanical function of the calcified leaflets. Starting from the evidences gained by mechanical decalcification of coronary arteries in interventional cardiology procedures, a practice already in the clinical setting, we will discuss the advantages and the potential drawbacks of valve lithotripsy devices and their potential applicability in the clinical scenario.
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8
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Leone PP, Scotti A, Ho EC, Assafin M, Doolittle J, Chau M, Slipczuk L, Levitus M, Regazzoli D, Mangieri A, Latib A. Prosthesis Tailoring for Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12. [PMID: 36615141 DOI: 10.3390/jcm12010338] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has risen over the past 20 years as a safe and effective alternative to surgical aortic valve replacement for treatment of severe aortic stenosis, and is now a well-established and recommended treatment option in suitable patients irrespective of predicted risk of mortality after surgery. Studies of numerous devices, either newly developed or reiterations of previous prostheses, have been accruing. We hereby review TAVI devices, with a focus on commercially available options, and aim to present a guide for prosthesis tailoring according to patient-related anatomical and clinical factors that may favor particular designs.
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9
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Tokuda T, Yamamoto M. Vascular management during transcatheter aortic valve replacement. Cardiovasc Interv Ther 2023; 38:18-27. [PMID: 36447120 DOI: 10.1007/s12928-022-00900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
Transcatheter aortic valve replacement (TAVR), as an alternative to open heart surgery, has been established as the standard therapy for patients with severe aortic valve stenosis. Vascular access management, the first step in a TAVR procedure, should be managed properly. Moreover, the transfemoral and alternatives such as the transaxillary/subclavian, transcarotid, transapical, and transcaval approaches are considered access routes during TAVR. More than 90% of cases can be treated via the transfemoral approach in the current TAVR era, whereas other approaches should be considered in patients in whom the transfemoral approach is not suitable. Vascular complications regardless of access route differences are a specific issue of TAVR caused by the use of large sheaths. With the increased number of TAVR cases, we must manage vascular complications and decrease the morbidity and mortality rates associated with TAVR procedures. Thus, this study aimed to review the vascular complications during TAVR and summarize their prognosis, prevention, and adequate management.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan.
| | - Masanori Yamamoto
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan. .,Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan. .,Department of Cardiology, Gifu Heart Center, Gifu, Japan.
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10
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Vetrovec GW, Kaki A, Wollmuth J, Dahle TG. Strategies for Reducing Vascular and Bleeding Risk for Percutaneous Left Ventricular Assist Device-supported High-risk Percutaneous Coronary Intervention. Heart Int 2022; 16:105-111. [PMID: 36741103 PMCID: PMC9872781 DOI: 10.17925/hi.2022.16.2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
In patients at high risk for haemodynamic instability during percutaneous coronary intervention (PCI), practitioners are increasingly opting for prophylactic mechanical circulatory support, such as the Impella® heart pump (Abiomed, Danvers, MA, USA). Though Impella-supported high-risk PCI (HRPCI) ensures haemodynamic stability during the PCI procedure, access-related complication rates have varied significantly in published studies. Reported variability in complication rates relates to many factors, including anticoagulation practices, access and closure strategy, post-procedure care and variations in event definitions. This article aims to outline optimal strategies to minimize vascular and bleeding complications during Impella-supported HRPCI based on previously identified clinical, procedural and postprocedural risk factors. Practices to reduce complications include femoral skills training, standardized protocols to optimize access, closure, anticoagulation management and post-procedural care, as well as the application of techniques and technological advances. Protocols integrating these strategies to mitigate access-related bleeding and vascular complications for Impella-supported procedures can markedly limit vascular access risk as a barrier to appropriate large-bore mechanical circulatory support use in HRPCI.
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Affiliation(s)
- George W Vetrovec
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amir Kaki
- Division of Cardiology, St. John’s Hospital, Wayne State University, Detroit, MI, USA
| | - Jason Wollmuth
- Providence Heart and Vascular Institute, Providence, OR, USA
| | - Thom G Dahle
- CentraCare Heart & Vascular Center, St. Cloud Hospital, St. Cloud, MN, USA
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11
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Schena S. Evolution of Alternative-Access Transcatheter Aortic Valve Replacement: Is an "Alternative" Access Still Needed? Ann Thorac Surg 2022; 114:2401-2402. [PMID: 35031290 DOI: 10.1016/j.athoracsur.2021.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Stefano Schena
- Division of Cardiac Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Zayed 7107, Baltimore, MD 21287.
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12
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Kalogeropoulos AS, Redwood SR, Allen CJ, Hurrell H, Chehab O, Rajani R, Prendergast B, Patterson T. A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence. Front Cardiovasc Med 2022; 9:971762. [PMID: 36479570 PMCID: PMC9719928 DOI: 10.3389/fcvm.2022.971762] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/31/2022] [Indexed: 07/26/2023] Open
Abstract
Since the first groundbreaking procedure in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis (AS). Through striking developments in pertinent equipment and techniques, TAVI has now become the leading therapeutic strategy for aortic valve replacement in patients with severe symptomatic AS. The procedure streamlining from routine use of conscious sedation to a single arterial access approach, the newly adapted implantation techniques, and the introduction of novel technologies such as intravascular lithotripsy and the refinement of valve-bioprosthesis devices along with the accumulating experience have resulted in a dramatic reduction of complications and have improved associated outcomes that are now considered comparable or even superior to surgical aortic valve replacement (SAVR). These advances have opened the road to the use of TAVI in younger and lower-risk patients and up-to-date data from landmark studies have now established the outstanding efficacy and safety of TAVI in patients with low-surgical risk impelling the most recent ESC guidelines to propose TAVI, as the main therapeutic strategy for patients with AS aged 75 years or older. In this article, we aim to summarize the most recent advances and the current clinical aspects involving the use of TAVI, and we also attempt to highlight impending concerns that need to be further addressed.
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Affiliation(s)
- Andreas S. Kalogeropoulos
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, MITERA General Hospital, Hygeia Healthcare Group, Athens, Greece
| | - Simon R. Redwood
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Christopher J. Allen
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Harriet Hurrell
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Omar Chehab
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Bernard Prendergast
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Tiffany Patterson
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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13
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Iacono G, Bressan M, Turicchia GU. Renal intravascular shockwave lithotripsy in complex mono Ch-EVAR. Vascular 2022:17085381221111020. [PMID: 36355623 DOI: 10.1177/17085381221111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Our objective is to present the Peripheral Intravascular Lithotripsy (IVL) System in the treatment of calcific renal artery stenosis (RAS) during Chimney Endovascular Aneurysm Repair (Ch-EVAR). The Ch-EVAR technique is a bail out procedure in treating aortic aneurysms with challenging anatomy regarding the proximal sealing zone. RAS typically involves varying degrees of calcification, and final treatment can be fraught with risk of vessel's damages and suboptimal results, particularly when renal angioplasty represents the only feasible course of action in Ch-EVAR. METHOD We present a case of a patient with a complex juxtarenal abdominal aortic aneurysm and a pre-obstructive chalky stenosis of the right renal artery who underwent mono ChEVAR associated to visceral Intravascular Lithotripsy shockwave angioplasty. CONCLUSION IVL is an attractive modality for the treatment of challenging, heavily calcified renal arteries that combines the calcium-disrupting capability of lithotripsy with the familiarity of balloon catheters to facilitate proper stent deployment. RESULT We propose the IVL system as an additional tool in the vascular surgeon's armamentarium not only to obtain large-bore access to enable Transaortic Valve Replacement (TAVR) and EVAR but also to perform angioplasty of severely calcified visceral arteries during Ch-EVAR.
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Affiliation(s)
- G Iacono
- Surgical and Major Trauma Department, AUSL Romagna,161128Vascular and Endovascular Surgery Unit of Cesena-Forlì, Cesena, Italy
| | - M Bressan
- School of Vascular Surgery, 9299University of Ferrara, Ferrara, Italy
| | - G U Turicchia
- Surgical and Major Trauma Department, AUSL Romagna,161128Vascular and Endovascular Surgery Unit of Cesena-Forlì, Cesena, Italy
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14
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Damluji AA, Tehrani B, Sinha SS, Samsky MD, Henry TD, Thiele H, West NEJ, Senatore FF, Truesdell AG, Dangas GD, Smilowitz NR, Amin AP, deVore AD, Moazami N, Cigarroa JE, Rao SV, Krucoff MW, Morrow DA, Gilchrist IC. Position Statement on Vascular Access Safety for Percutaneous Devices in AMI Complicated by Cardiogenic Shock. JACC Cardiovasc Interv 2022; 15:2003-2019. [PMID: 36265932 PMCID: PMC10312149 DOI: 10.1016/j.jcin.2022.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 01/09/2023]
Abstract
In the United States, the frequency of using percutaneous mechanical circulatory support devices for acute myocardial infarction complicated by cardiogenic shock is increasing. These devices require large-bore vascular access to provide left, right, or biventricular cardiac support, frequently under urgent/emergent circumstances. Significant technical and logistical variability exists in device insertion, care, and removal in the cardiac catheterization laboratory and in the cardiac intensive care unit. This variability in practice may contribute to adverse outcomes observed in centers that receive patients with cardiogenic shock, who are at higher risk for circulatory insufficiency, venous stasis, bleeding, and arterial hypoperfusion. In this position statement, we aim to: 1) describe the public health impact of bleeding and vascular complications in cardiogenic shock; 2) highlight knowledge gaps for vascular safety and provide a roadmap for a regulatory perspective necessary for advancing the field; 3) propose a minimum core set of process elements, or "vascular safety bundle"; and 4) develop a possible study design for a pragmatic trial platform to evaluate which structured approach to vascular access drives most benefit and prevents vascular and bleeding complications in practice.
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Affiliation(s)
- Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA; Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | - Behnam Tehrani
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Shashank S Sinha
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Marc D Samsky
- New York University School of Medicine, New York, New York, USA
| | - Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education, Christ Hospital, Cincinnati, Ohio, USA
| | - Holger Thiele
- Heart Center Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Fortunato F Senatore
- Division of Cardiology and Nephrology, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Alexander G Truesdell
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - George D Dangas
- Division of Cardiology, Department of Medicine, Mount Sinai Hospital, New York, New York, USA
| | | | - Amit P Amin
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Adam D deVore
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Nader Moazami
- New York University School of Medicine, New York, New York, USA
| | | | - Sunil V Rao
- New York University School of Medicine, New York, New York, USA
| | | | - David A Morrow
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ian C Gilchrist
- Penn State Heart and Vascular Institute, Hershey Medical Center, Hershey, Pennsylvania, USA
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15
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Masiero G, Paradies V, Franzone A, Bellini B, De Biase C, Karam N, Sanguineti F, Mamas MA, Eltchaninoff H, Fraccaro C, Castiglioni B, Attisano T, Esposito G, Chieffo A. Sex-Specific Considerations in Degenerative Aortic Stenosis for Female-Tailored Transfemoral Aortic Valve Implantation Management. J Am Heart Assoc 2022; 11:e025944. [PMID: 36172929 DOI: 10.1161/jaha.121.025944] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The impact of sex on pathophysiological processes, clinical presentation, treatment options, as well as outcomes of degenerative aortic stenosis remain poorly understood. Female patients are well represented in transfemoral aortic valve implantation (TAVI) trials and appear to derive favorable outcomes with TAVI. However, higher incidences of major bleeding, vascular complications, and stroke have been reported in women following TAVI. The anatomical characteristics and pathophysiological features of aortic stenosis in women might guide a tailored planning of the percutaneous approach. We highlight whether a sex-based TAVI management strategy might impact on clinical outcomes. This review aimed to evaluate the impact of sex from diagnosis to treatment of degenerative aortic stenosis, discussing the latest evidence on epidemiology, pathophysiology, clinical presentation, therapeutic options, and outcomes. Furthermore, we focused on technical sex-oriented considerations in TAVI including the preprocedural screening, device selection, implantation strategy, and postprocedural management.
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Affiliation(s)
- Giulia Masiero
- Department of Cardiac, Thoracic Vascular Science and Public Health, University of Padova Italy
| | - Valeria Paradies
- Department of Cardiology Maasstad Hospital Rotterdam The Netherlands
| | - Anna Franzone
- Department of Advanced Biomedical Sciences Federico II University of Naples Italy
| | - Barbara Bellini
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel Clinique Pasteur Toulouse France
| | - Nicole Karam
- Cardiology Department European Hospital Georges Pompidou Paris France
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group School of Medicine, Keele University Stoke-on-Trent United Kingdom.,Department of Cardiology Royal Stoke University Hospital Stoke-on-Trent United Kingdom.,Department of Medicine Thomas Jefferson University Philadelphia PA
| | | | - Chiara Fraccaro
- Department of Cardiac, Thoracic Vascular Science and Public Health, University of Padova Italy
| | | | - Tiziana Attisano
- Division of Interventional Cardiology Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi Salerno Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences Federico II University of Naples Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
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16
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Sohal S, Mehta H, Kurpad K, Mathai SV, Tayal R, Visveswaran GK, Wasty N, Waxman S, Cohen M, Musialek P. Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis. J Interv Cardiol 2022; 2022:1-6. [PMID: 36262460 PMCID: PMC9553752 DOI: 10.1155/2022/5688026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. The last decade has witnessed major evolution and shifts in the use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Included among the shifts has been the advent of alternative access sites for TAVR. Consequently, transapical access (TA) has become significantly less common. This study analyzes in detail the trend of TA access for TAVR over the course of 7 years. Methods. The national inpatient sample database was reviewed from 2011–2017 and patients with AS were identified by using validated ICD 9-CM and ICD 10-CM codes. Patients who underwent TAVR through TA access were classified as TA-TAVR, and any procedure other than TA access was classified as non-TA-TAVR. We compared the yearly trends of TA-TAVR to those of non-TA-TAVR as the primary outcome. Results. A total of 3,693,231 patients were identified with a diagnosis of AS. 129,821 patients underwent TAVR, of which 10,158 (7.8%) underwent TA-TAVR and 119,663 (92.2%) underwent non-TA-TAVR. After peaking in 2013 at 27.7%, the volume of TA-TAVR declined to 1.92% in 2017 (
). Non-TA-TAVR started in 2013 at 72.2% and consistently increased to 98.1% in 2017. In-patient mortality decreased from a peak of 5.53% in 2014 to 3.18 in 2017 (
) in the TA-TAVR group and from a peak of 4.51% in 2013 to 1.24% in 2017 (
) in the non-TA-TAVR group. Conclusion. This study highlights a steady decline in TA access for TAVR, higher inpatient mortality, increased length of stay, and higher costs compared to non-TA-TAVR.
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17
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Sawan MA, Calhoun AE, Grubb KJ, Devireddy CM. Update on Minimalist TAVR Care Pathways: Approaches to Care in 2022. Curr Cardiol Rep 2022. [PMID: 35767177 DOI: 10.1007/s11886-022-01737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/20/2022]
Abstract
Purpose of Review This review summarizes current data supporting a minimalist TAVR approach and identifies the need for additional study to optimize TAVR care. The authors discuss future directions of the TAVR landscape and how this necessitates evolution of minimalist care pathways. Recent Findings Transcatheter aortic valve replacement (TAVR) has become a mainstay in the treatment of aortic stenosis since the initial procedure in 2002. Recently, attention has shifted to TAVR optimization and the minimalist approach with a focus on minimizing procedural sedation, protocolization of perioperative management, and prioritization on early discharge. This approach has been shown to be safe and reduce procedure time, length of stay, and overall cost for hospital systems. Summary The minimalist care pathway avoids general anesthesia, shortens procedure time and length of stay, and reduces cost without changing mortality or readmission rates at 30 days. A variety of protocols have been proposed without a clear consensus on specific components or patient eligibility. There is a continued need for data regarding patient risk stratification, valve selection, and discharge strategy as TAVR becomes increasingly common.
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18
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Nasiri A, Kim H, Gurusamy V, Benenati JF. Management of Calcification: Rational and Technical Considerations for Intravascular Lithotripsy. Tech Vasc Interv Radiol 2022; 25:100841. [DOI: 10.1016/j.tvir.2022.100841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Nardi G, De Backer O, Saia F, Sondergaard L, Ristalli F, Meucci F, Stolcova M, Mattesini A, Demola P, Wang X, Al Jabri A, Palmerini T, Bruno AG, Ielasi A, Van Belle E, Berti S, Di Mario C. Peripheral intravascular lithotripsy for transcatheter aortic valve implantation: a multicentre observational study. EUROINTERVENTION 2022; 17:e1397-e1406. [PMID: 34734559 PMCID: PMC9896402 DOI: 10.4244/eij-d-21-00581] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The presence of severe calcific atherosclerosis at the iliofemoral axis may preclude transcatheter aortic valve implantation (TAVI) by the transfemoral (TF) approach. Intravascular lithotripsy (IVL) is a novel technology that fractures intimal/medial calcium and increases vessel compliance allowing TF TAVI in selected patients with peripheral artery disease (PAD). AIMS The aim of this study was to report on the safety and efficacy of IVL-assisted TF TAVI in an all-comers population. METHODS Clinical, imaging and procedural data on all consecutive patients treated by IVL-assisted TF TAVI in six high-volume European centres (2018-2020) were collected in this prospective, real-world, multicentre registry. RESULTS IVL-assisted TF TAVI was performed in 108 patients, increasing from 2.4% to 6.5% of all TAVI from 2018 to 2020, respectively. The target lesion was most often localised at the common and/or external iliac artery (93.5% of cases; average TL-MLD 4.6±0.9 mm with 318 degrees of calcium arc). Transfemoral aortic valve delivery was successful in 100% of cases; final procedural success in 98.2% (two conversions to cardiac open surgery for annular rupture and valve migration). Complications of the IVL-treated segments consisted of 1 perforation and 3 major dissections requiring stent implantation (2 covered stents and 2 BMS). Access-site-related complications included 3 major bleedings. Three in-hospital deaths were recorded (2.8%, 1 failed surgical conversion after annular rupture, 1 cardiac arrest after initial valvuloplasty, 1 late hyperkalaemia in renal dysfunction). CONCLUSIONS IVL-assisted TF TAVI proved to be a safe and effective approach, which helps to expand the indications for TF TAVI in patients with severe calcific PAD. However, these patients continue to have a higher-than-average incidence of periprocedural complications.
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Affiliation(s)
- Giulia Nardi
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Francesco Saia
- Interventional Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Francesca Ristalli
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Pierluigi Demola
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Xi Wang
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Tullio Palmerini
- Interventional Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Antonio Giulio Bruno
- Interventional Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Alfonso Ielasi
- Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, Lille, France
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21
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Ozdemir D, Karimi Galougahi K, Petrossian G, Ezratty C, Dominguez-Sulca D, Chowdhury E, Scheiner J, Thomas SV, Shlofmitz RA, Ali ZA. Calcific Plaque Modification by Acoustic Shockwaves: Intravascular Lithotripsy in Cardiovascular Interventions. Curr Cardiol Rep 2022; 24:519-528. [PMID: 35286663 DOI: 10.1007/s11886-022-01674-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide a review of recent literature on the treatment of moderate-to-severe calcification in coronary and peripheral vasculature with intravascular lithotripsy (Shockwave Medical, Santa Clara, CA). RECENT FINDINGS Moderate-to-severe calcific plaques constitute a significant proportion of lesions treated with transcatheter interventions in the coronary and peripheral vascular beds and portend lower procedural success rates, increased periprocedural major adverse events, and unfavorable long-term clinical outcomes compared to non-calcific plaques. Intravascular lithotripsy (IVL) is a new technique that uses acoustic shock waves in a balloon-based system to induce fracture in the calcium deposits to facilitate luminal gain and stent expansion. IVL demonstrated high procedural success and low complication rates in the management of moderate-to-severe calcification in coronary and peripheral vascular beds and led to large luminal gain by modification of calcific plaque as assessed by optical coherence tomography. Further studies will determine the role of IVL in an integrated, protocolized approach to the treatment of severely calcified plaques in the coronary and peripheral vascular beds.
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Affiliation(s)
| | - Keyvan Karimi Galougahi
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Heart Research Institute, Sydney, Australia
| | | | - Charlotte Ezratty
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Saint Francis Hospital, Cardiovascular Research Foundation, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Dylan Dominguez-Sulca
- Saint Francis Hospital, Cardiovascular Research Foundation, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Elma Chowdhury
- Saint Francis Hospital, Cardiovascular Research Foundation, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Jonathan Scheiner
- Saint Francis Hospital, Cardiovascular Research Foundation, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Susan V Thomas
- Saint Francis Hospital, Cardiovascular Research Foundation, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Richard A Shlofmitz
- Saint Francis Hospital, Cardiovascular Research Foundation, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Ziad A Ali
- Saint Francis Hospital, Cardiovascular Research Foundation, 100 Port Washington Blvd, Roslyn, NY, USA.
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.
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22
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23
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Sanders KM, Schneider PA, Conte MS, Iannuzzi JC. Endovascular treatment of high-risk peripheral vascular occlusive lesions: a review of current evidence and emerging applications of intravascular lithotripsy, atherectomy, and paclitaxel-coated devices. Semin Vasc Surg 2021; 34:172-187. [PMID: 34911623 DOI: 10.1053/j.semvascsurg.2021.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/11/2022]
Abstract
Endovascular treatment of peripheral arterial disease has evolved and expanded rapidly over the last 20 years. New technologies have increased the diversity of devices available and have made it possible to approach even the most challenging and high-risk lesions using endovascular techniques. In this review, we examine the clinical evidence available for several categories of endovascular devices available to treat peripheral arterial disease, including intravascular lithotripsy, atherectomy, and drug-coated devices. The best application for some technologies, such as intravascular lithotripsy and atherectomies, have yet to be identified. In contrast, drug-coated devices have an established role in patients at high risk for long-term failure, but have been the subject of much controversy, given recent concerns about possible adverse effects of paclitaxel. Future investigation should further assess these technologies in patients with complex disease using updated staging systems and outcomes with direct clinical relevance, such as functional improvement, wound healing, and freedom from recurrent symptoms.
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Affiliation(s)
- Katherine M Sanders
- Division of Vascular and Endovascular Surgery, 400 Parnassus Avenue, A-501, San Francisco, CA, 94143-0957
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, 400 Parnassus Avenue, A-501, San Francisco, CA, 94143-0957
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, 400 Parnassus Avenue, A-501, San Francisco, CA, 94143-0957
| | - James C Iannuzzi
- Division of Vascular and Endovascular Surgery, 400 Parnassus Avenue, A-501, San Francisco, CA, 94143-0957.
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24
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Ranka S, Lahan S, Chhatriwalla AK, Allen KB, Chiang M, O'Neill B, Verma S, Wang DD, Lee J, Frisoli T, Eng M, Bagur R, O'Neill W, Villablanca P. Network meta-analysis comparing the short and long-term outcomes of alternative access for transcatheter aortic valve replacement. Cardiovasc Revasc Med 2021; 40:1-10. [PMID: 34972667 DOI: 10.1016/j.carrev.2021.11.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have pair-wise compared access sites for transcatheter aortic valve replacement (TAVR) but pooled estimate of overall comparative efficacy and safety outcomes are not well known. We sought to compare short- and long-term outcomes following various alternative access routes for TAVR. METHODS Thirty-four studies with a pooled sample size of 32,756 patients were selected by searching PubMed and Cochrane library databases from inception through 11th June 2021 for patients undergoing TAVR via 1 of 6 different access sites: Transfemoral (TF), Transaortic (TAO), Transapical (TA), Transcarotid (TC), Transaxillary/Subclavian (TSA), and Transcaval (TCV). Data were extracted to conduct a frequentist network meta-analysis with a random-effects model using TF access as a reference group. RESULTS Compared with TF, both TAO [RR 1.91, 95% CI (1.46-2.50)] and TA access [RR 2.12, 95% CI (1.84-2.46)] were associated with an increased risk of 30-day mortality. No significant difference was observed for stroke, myocardial infarction, major bleeding, conversion to open surgery, and major adverse cardiovascular or cerebrovascular events at 30 days between different accesses. Major vascular complications were lower in TA [RR 0.43, (95% CI, 0.28-0.67)] and TC [RR 0.51, 95% CI (0.35-0.73)] access compared to TF. The 1-year mortality was higher in TAO [RR of 1.35, (95% CI, 1.01-1.81)] and TA [RR 1.44, (95% CI, 1.14-1.81)] groups. CONCLUSION Non-thoracic alternative access site utilization for TAVR implantation (TC, TSA and TCV) is associated with outcomes similar to conventional TF access. Thoracic TAVR access (TAO and TA) translates into increased short and long-term mortality.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shubham Lahan
- Division of Cardiovascular Prevention & Wellness, Department of Cardiology, Houston Methodist, Houston, TX, United States
| | - Adnan K Chhatriwalla
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Michael Chiang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Brian O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Sadhika Verma
- Department of Family Medicine, Henry Ford Allegiance Health, Jackson, MI, United States
| | - Dee Dee Wang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - James Lee
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Tiberio Frisoli
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Marvin Eng
- Department of Cardiology, Banner University Medical Center, Phoenix, AZ, United States
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - William O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Pedro Villablanca
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States.
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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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26
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Cerillo AG, Pennesi M, Iannone L, Giustini G, de Cillis P, Valenti R, Marchionni N, Stefano P. Case Report: Lithoplasty-Assisted Trans-Axillary Transcatheter Aortic Valve-in-Valve Implantation. Front Cardiovasc Med 2021; 8:747588. [PMID: 34746261 PMCID: PMC8564067 DOI: 10.3389/fcvm.2021.747588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
We present the case of a severely symptomatic patient with a malfunctioning aortic bioprosthesis and severe multidistrict atherosclerosis that was addressed to our unit for transcatheter valve-in-valve implantation. The imaging and clinical assessment that led to the selection of the access route is discussed.
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Affiliation(s)
| | - Matteo Pennesi
- Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Luisa Iannone
- Unit of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Giorgia Giustini
- Unit of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Paolo de Cillis
- Unit of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Renato Valenti
- Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- General Cardiology, Careggi University Hospital, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence School of Medicine, Florence, Italy
| | - Pierluigi Stefano
- Unit of Cardiac Surgery, Careggi University Hospital, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence School of Medicine, Florence, Italy
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27
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Mach M, Okutucu S, Kerbel T, Arjomand A, Fatihoglu SG, Werner P, Simon P, Andreas M. Vascular Complications in TAVR: Incidence, Clinical Impact, and Management. J Clin Med 2021; 10:jcm10215046. [PMID: 34768565 PMCID: PMC8584339 DOI: 10.3390/jcm10215046] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR.
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Affiliation(s)
- Markus Mach
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
- Correspondence: ; Tel.: +43-1-40400-52620
| | - Sercan Okutucu
- Department of Cardiology, Memorial Ankara Hospital, 06520 Ankara, Turkey;
| | - Tillmann Kerbel
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Aref Arjomand
- Department of Cardiology, St. John of God Hospital, Geelong, VIC 3220, Australia;
| | | | - Paul Werner
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Paul Simon
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
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28
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Perrin N, Bonnet G, Leroux L, Ibrahim R, Modine T, Ben Ali W. Transcatheter Aortic Valve Implantation: All Transfemoral? Update on Peripheral Vascular Access and Closure. Front Cardiovasc Med 2021; 8:747583. [PMID: 34660747 PMCID: PMC8511676 DOI: 10.3389/fcvm.2021.747583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/30/2021] [Indexed: 12/19/2022] Open
Abstract
Transfemoral access remains the most widely used peripheral vascular approach for transcatheter aortic valve implantation (TAVI). Despite technical improvement and reduction in delivery sheath diameters of all TAVI platforms, 10-20% of patients remain not eligible to transfemoral TAVI due to peripheral artery disease. In this review, we aim at presenting an update of recent data concerning transfemoral access and percutaneous closure devices. Moreover, we will review peripheral non-transfemoral alternative as well as caval-aortic accesses and discuss the important features to assess with pre-procedural imaging modalities before TAVI.
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Affiliation(s)
- Nils Perrin
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada.,Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Guillaume Bonnet
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Lionel Leroux
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Réda Ibrahim
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Walid Ben Ali
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada.,Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
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29
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Glaser N, O'Sullivan CJ, Saleh N, Verouhis D, Settergren M, Linder R, Rück A. Transcatheter aortic valve replacement using the iSleeve expandable sheath in small femoral arteries. Open Heart 2021; 8:openhrt-2021-001703. [PMID: 34642241 PMCID: PMC8513271 DOI: 10.1136/openhrt-2021-001703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background Small femoral arteries have been associated with a higher risk of vascular complications in transfemoral transcatheter aortic valve replacement (TAVR). We investigated the feasibility and safety of TAVR in patients with small femoral arteries. Methods In this observational study, we included 82 patients who underwent transfemoral TAVR with the ACURATE neo system using the expandable 14F iSleeve sheath between 2018 and 2019 at Karolinska University Hospital, Sweden. Of these, 41 patients had a minimal femoral artery diameter of ≥5.5 mm (mean 6.5, range 5.5–9.2), and 41 patients had a minimal femoral artery diameter <5.5 mm (mean 4.9, range 3.9–5.4). Results There was no significant difference in major vascular and bleeding complications between the small femoral artery group (7%) and the normal femoral artery group (2%) (p=0.62). The total of major and minor vascular complications did not differ significantly according to femoral artery size (17% vs 5%) (p=0.16). The iSleeve sheath was not correlated with any of the complications. The use of the iSleeve sheath was unsuccessful in four patients (5%), of which one patient had a small femoral artery diameter. Conclusion Transfemoral TAVR with the ACURATE neo system using the iSleeve sheath is a promising method for patients with small femoral arteries even though we found a trend towards higher rates of complications in these patients. The use of expandable sheaths may expand the spectrum of patients that can be treated with transfemoral TAVR, and thus may improve the prognosis in patients with severe aortic valve stenosis.
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Affiliation(s)
- Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden .,Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Crochan J O'Sullivan
- Department of Cardiology, Bon Secours Hospital, Cork, Ireland.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nawzad Saleh
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dinos Verouhis
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Linder
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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30
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Sawaya FJ, Bajoras V, Vanhaverbeke M, Wang C, Bieliauskas G, Søndergaard L, De Backer O. Intravascular Lithotripsy-Assisted Transfemoral TAVI: The Copenhagen Experience and Literature Review. Front Cardiovasc Med 2021; 8:739750. [PMID: 34631837 PMCID: PMC8492918 DOI: 10.3389/fcvm.2021.739750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is currently an established therapy for elderly patients with symptomatic severe aortic valve stenosis across all surgical risk categories. Access is an important aspect when planning for and performing TAVI. The superiority of a transfemoral (TF) approach compared to a transthoracic (transapical, direct aortic) approach has been demonstrated in several studies. Recently, the introduction of intravascular lithotripsy (IVL) has made it possible to treat patients with calcified iliofemoral disease by TF approach. This article aimed to provide a comprehensive overview on the following aspects: (1) preprocedural planning for IVL-assisted TF-TAVI; (2) procedural aspects in IVL-assisted TF-TAVI; (3) outcomes of IVL-assisted TF-TAVI in an experienced TAVI center; and (4) literature review and discussion of this new emerging approach.
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Affiliation(s)
- Fadi J Sawaya
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vilhelmas Bajoras
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Wang
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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31
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Tugaoen Z, Nguyen P, Arora S, Vavalle J. The selection of transcatheter heart valves in transcatheter aortic valve replacement. Trends Cardiovasc Med 2021; 32:513-522. [PMID: 34634481 DOI: 10.1016/j.tcm.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Transcatheter heart valve technology has rapidly progressed since initial approval in the United States. There are currently two widely available transcatheter heart valve delivery systems approved in the US; however limited data exist on optimal device selection for various patient populations. This review explores the characteristics of currently approved transcatheter heart valve systems and scenarios where one valve system may be favored over others. We provide a simplified decision tree for selecting the optimal transcatheter valve system for specific patient-centered characteristics.
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Affiliation(s)
- Zachary Tugaoen
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Peter Nguyen
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - Sameer Arora
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States
| | - John Vavalle
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States.
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32
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Ciardetti N, Ciatti F, Nardi G, Di Muro FM, Demola P, Sottili E, Stolcova M, Ristalli F, Mattesini A, Meucci F, Di Mario C. Advancements in Transcatheter Aortic Valve Implantation: A Focused Update. Medicina (Kaunas) 2021; 57:711. [PMID: 34356992 PMCID: PMC8306774 DOI: 10.3390/medicina57070711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 01/07/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65-75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Clinica Medica, Room 124, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy; (N.C.); (F.C.); (G.N.); (F.M.D.M.); (P.D.); (E.S.); (M.S.); (F.R.); (A.M.); (F.M.)
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33
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Balan P, Eng MH. Equality in matters of the heart? Catheter Cardiovasc Interv 2021; 98:184. [PMID: 34219372 DOI: 10.1002/ccd.29815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Prakash Balan
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Marvin H Eng
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
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34
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Karimi Galougahi K, Soukas PA, Kolski B, Tayal R, Parikh SA, Armstrong EJ, Petrossian G, Kaki A, Rosenfield K, Gray WA, Ali ZA. Acoustic shock waves to modify calcific plaques - Intravascular lithotripsy in the peripheral circulation. Cardiovasc Revasc Med 2021; 37:135-144. [PMID: 34187754 DOI: 10.1016/j.carrev.2021.06.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/01/2021] [Accepted: 06/22/2021] [Indexed: 12/23/2022]
Abstract
Intravascular lithotripsy (IVL) is a new technique for treatment of severely calcified lesions that uses acoustic shockwaves in a balloon-based system to induce fracture in calcific plaque, facilitating luminal gain and vessel expansion. In this review, we provide a concise summary of the available data and clinical experience of IVL in various peripheral vascular beds, including facilitating vascular access for large-bore devices. We discuss the physics and mode of action of IVL in modifying calcified plaques, include several illustrative examples of utility of IVL in peripheral interventions, and discuss the future directions for adoption of the technique in peripheral interventions.
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Affiliation(s)
- Keyvan Karimi Galougahi
- Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Heart Research Institute, Sydney, Australia
| | - Peter A Soukas
- The Miriam Hospital/Brown Medical School, Providence, RI, United States of America
| | - Brian Kolski
- Department of Cardiology, St Joseph Hospital, Orange, CA, United States of America
| | - Rajiv Tayal
- University of Medicine and Dentistry of New Jersey, Newark, NJ, United States of America
| | - Sahil A Parikh
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, United States of America
| | - Ehrin J Armstrong
- University of Colorado School of Medicine, Aurora, CO, United States of America
| | - George Petrossian
- DeMatteis Cardiovascular Institute, St Francis Hospital, Roslyn, NY, United States of America
| | - Amir Kaki
- Ascension Health, Detroit, MI, United States of America
| | | | - William A Gray
- Main Line Health/Lankenau Heart Institute, Wynnewood, PA, United States of America
| | - Ziad A Ali
- DeMatteis Cardiovascular Institute, St Francis Hospital, Roslyn, NY, United States of America; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States of America.
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35
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Diepenbruck S, Dalla-Pozza R, Pattathu J, Haas N, Jakob A. Successful intravascular pulmonary lithotripsy in a child with chronic thromboembolic pulmonary hypertension. Pediatr Pulmonol 2021; 56:1690-1693. [PMID: 33634582 DOI: 10.1002/ppul.25338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 11/07/2022]
Abstract
Intravascular lithotripsy (IVL) is a novel method based on pulsatile ultrasonic pressure waves specifically aimed to modify circumferential and transmural calcium plaques. We report on the successful application of a shockwave IVL catheter® in a child with chronic thromboembolic pulmonary hypertension due to calcified thrombi in both lower lobes. Compared to conventional high-pressure balloon angioplasty, a significant perfusion-improvement was achieved with a shockwave IVL catheter® (4 mm) of the treated right pulmonary artery branch. Furthermore, subsequent surgical thrombectomy was reported to be considerably easier for the shockwave-treated thrombotic areas than the high-pressure balloon-only-treated thrombus. In conclusion, the shockwave IVL catheter® may be a promising option in chronic thromboembolic lesions in PA (pulmonary artery) position, and furthermore might be an option when treating children.
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Affiliation(s)
- Sabine Diepenbruck
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Robert Dalla-Pozza
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Joseph Pattathu
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Nikolaus Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - André Jakob
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians-University of Munich, Munich, Germany
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36
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Kereiakes DJ, Virmani R, Hokama JY, Illindala U, Mena-Hurtado C, Holden A, Hill JM, Lyden SP, Ali ZA. Principles of Intravascular Lithotripsy for Calcific Plaque Modification. JACC Cardiovasc Interv 2021; 14:1275-1292. [PMID: 34167671 DOI: 10.1016/j.jcin.2021.03.036] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 01/14/2023]
Abstract
A significant proportion of lesions treated with transcatheter interventions in the coronary and peripheral vascular beds exhibit moderate to severe calcific plaques known to portend lower procedural success rates, increased peri-procedural adverse events, and unfavorable clinical outcomes compared with noncalcific plaques. Adapted from lithotripsy technology used for treatment of ureterorenal calculi, intravascular lithotripsy (IVL) is a novel technique for the treatment of severely calcific plaque lesions that uses acoustic shockwaves in a balloon-based delivery system. Shockwaves induce calcium fractures, which facilitate stent expansion and luminal gain. In this review, the authors summarize the physics, preclinical and clinical data on IVL use in the coronary and peripheral vasculature, and future directions of IVL in transcatheter cardiovascular therapies.
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Affiliation(s)
- Dean J Kereiakes
- The Christ Hospital and Lindner Research Center, Cincinnati, Ohio, USA.
| | - Renu Virmani
- Cardiovascular Pathology Institute, Gaithersburg, Maryland, USA
| | | | | | - Carlos Mena-Hurtado
- Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Ziad A Ali
- Columbia University Medical Center, New York, New York, USA
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37
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Virk HUH, Tabaza L, Almas T, George JC. Contemporary Role of Intravascular Lithotripsy in the Management of Peripheral Artery Disease. Curr Treat Options Cardio Med 2021; 23. [DOI: 10.1007/s11936-021-00925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Abstract
Transcatheter aortic valve replacement has emerged as the standard treatment for the majority of patients with symptomatic aortic stenosis. As transcatheter aortic valve replacement expands to patients across all risk groups, optimal patient selection strategies and device implantation techniques become increasingly important. A significant number of patients referred for transcatheter aortic valve replacement present with challenging anatomies and clinical indications that had been historically considered a contraindication for transcatheter aortic valve replacement. This article aims to highlight and discuss some of the potential obstacles that are encountered in clinical practice with a particular emphasis on bicuspid aortic valve disease.
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Affiliation(s)
- Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
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39
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Mangieri A, Laricchia A, Montalto C, Palena ML, Fisicaro A, Cereda A, Sticchi A, Latib A, Giannini F, Khokhar AA, Colombo A. Patient selection, procedural planning and interventional guidance for transcatheter aortic valve intervention. Minerva Cardiol Angiol 2021; 69:671-683. [PMID: 33703862 DOI: 10.23736/s2724-5683.21.05573-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis across a broad spectrum of patient risk profiles. Pre-procedural planning using multislice computed tomography (MSCT) is a fundamental component to ensure acute and long-term procedural success. MSCT can establish the procedural feasibility, the type vascular of approach as well as the device which is more likely to give a good result. Moreover, MSCT is a key tool to estimate the risk of potentially life-threatening complications. In this review, the role of MSCT for pre-procedural TAVR planning will be discussed providing a panoramic overview of the key elements that should be considered when performing TAVR. Additionally, the adjunctive role of fluoroscopy and echocardiography to plan and guide a TAVR procedure will also be discussed.
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Affiliation(s)
- Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy -
| | - Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariano L Palena
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Andrea Fisicaro
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alberto Cereda
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alessandro Sticchi
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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40
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Tayal R, Sohal S, Okoh A, Wasty N, Waxman S, Salemi A. Intravascular Lithotripsy Enabled Transfemoral Transcatheter Aortic Valve Implantation via Percutaneous Axillary Access Approach. Cardiovasc Revasc Med 2021; 28S:89-93. [PMID: 33358548 DOI: 10.1016/j.carrev.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/15/2020] [Indexed: 11/23/2022]
Abstract
Transfemoral (TF) access for transcatheter aortic valve implantation (TAVI) is the most commonly used site, however its use may be limited by prohibitive peripheral arterial disease. Although a number of alternative access techniques have been well described, each has been shown to be associated with increased risks when compared to a TF approach. Recently, planned treatment of iliofemoral artery disease using intravascular lithotripsy (IVL) has emerged as a means of preserving TF access. Ipsilateral or contralateral femoral artery access has been routinely used to perform IVL but its use may be limited in certain conditions. Here we describe the novel technique of using percutaneous axillary artery access to perform IVL of iliofemoral artery to facilitate its use for large bore access. We present a 78-year-old high surgical risk female with severe aortic stenosis who was found to have a prior stent in the contralateral iliac artery protruding into the aorta which limited a traditional 'up and over' approach, and thus axillary artery access was used to perform IVL. This is the first case in literature to describe the use of percutaneous axillary access to perform IVL of the iliac and common femoral artery to facilitate TF TAVI. Based on our previous experience we feel this technique holds promise for a routine use when use of other access sites is limited.
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41
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Abstract
Renal artery stenosis (RAS) typically involves varying degrees of calcification, and treatment can be fraught with risk and suboptimal results. Intravascular lithotripsy (IVL) uses shockwaves to fragment calcium to facilitate angioplasty. We present a case of severe bilateral RAS successfully treated with IVL and stenting after conventional methods had failed. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Danielle Lee
- Department of Internal Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
| | - Jennifer Kinaga
- Department of Cardiology, Orlando Regional Medical Center, Orlando, Florida, USA
| | - Vijaykumar Kasi
- Department of Cardiology, Orlando Regional Medical Center, Orlando, Florida, USA.,Orlando Health Heart Institute, Orlando, Florida, USA
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42
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Henry CL, Hansen SK, Gable CE, Grimsley BR, Gable DR. Intravascular lithotripsy during transcarotid arterial revascularization for highly calcified lesions in high-risk patients. J Vasc Surg Cases Innov Tech 2020; 7:68-73. [PMID: 33665535 PMCID: PMC7903196 DOI: 10.1016/j.jvscit.2020.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022]
Abstract
Transcarotid arterial revascularization (TCAR) with flow reversal offers a less invasive option for carotid revascularization in high-risk surgical patients. TCAR has been shown to have similar complication rates for stroke and mortality compared with carotid endarterectomy and lower complication rates compared with transfemoral carotid artery stenting. A relative contraindication for carotid stenting includes heavily calcified lesions. Intravascular lithotripsy has been approved for use in other vascular beds for endovascular treatment of heavily calcified lesions. In the present report, we have demonstrated the application of intravascular lithotripsy for heavily calcified carotid lesions, enabling treatment with TCAR for those who otherwise might be at high risk of transfemoral carotid artery stenting or carotid endarterectomy.
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Affiliation(s)
- Christopher L Henry
- Department of Vascular Surgery, Baylor Scott & White Heart and Vascular Hospital, Dallas, Tex
| | - Spencer K Hansen
- Department of Vascular and Endovascular Surgery, Baylor Scott & White Heart Hospital Plano, Plano, Tex
| | - Cara E Gable
- College of Vetenary Medicine and Biomedical Sciences, Texas A&M University, College Station, Tex
| | - Bradley R Grimsley
- Department of Vascular Surgery, Baylor Scott & White Heart and Vascular Hospital, Dallas, Tex
| | - Dennis R Gable
- Department of Vascular and Endovascular Surgery, Baylor Scott & White Heart Hospital Plano, Plano, Tex
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43
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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] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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44
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Ristalli F, Maiani S, Mattesini A, Stolcova M, Meucci F, Hamiti B, Valente S, Di Mario C. Intravascular Lithotripsy and Impella Support to Assist Complex LM Angioplasty. Cardiovascular Revascularization Medicine 2020; 21:143-146. [DOI: 10.1016/j.carrev.2019.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
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45
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Kassimis G, Banning AP. Reply to the Letter to the Editor Entitled "Intravascular Lithotripsy Facilitated Cardiovascular Interventions". Angiology 2020; 72:98. [PMID: 33021101 DOI: 10.1177/0003319720963603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- George Kassimis
- 2nd Cardiology Department, 69200Aristotle University of Thessaloniki, Hippokration Hospital, Greece.,1st Cardiology Department, AHEPA General Hospital, 69200Aristotle University of Thessaloniki, Greece
| | - Adrian P Banning
- Oxford Heart Centre, 11269John Radcliffe Hospital, Oxford, United Kingdom
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46
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Tsanaxidis N, Wrigley B, Collins M, Cotton J. A valve-in-valve (ViV) transcatheter aortic valve implantation with lithotripsy-assisted transfemoral approach. Eur Heart J Case Rep 2020; 4:1-2. [PMID: 33204961 PMCID: PMC7649463 DOI: 10.1093/ehjcr/ytaa261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/09/2020] [Accepted: 07/13/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Nikolaos Tsanaxidis
- Cardiology Department, New Cross Hospital, Heart & Lung Centre, Royal Wolverhampton NHS Trust, WV10 0QP, UK
| | - Benjamin Wrigley
- Cardiology Department, New Cross Hospital, Heart & Lung Centre, Royal Wolverhampton NHS Trust, WV10 0QP, UK
| | - Michael Collins
- Cardiology Department, New Cross Hospital, Heart & Lung Centre, Royal Wolverhampton NHS Trust, WV10 0QP, UK
| | - James Cotton
- Cardiology Department, New Cross Hospital, Heart & Lung Centre, Royal Wolverhampton NHS Trust, WV10 0QP, UK
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47
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Southmayd G, Hoque A, Kaki A, Tayal R, Rab ST. Percutaneous
large‐bore
axillary access is a safe alternative to surgical approach: A systematic review. Catheter Cardiovasc Interv 2020; 96:1481-1488. [DOI: 10.1002/ccd.29273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/30/2020] [Accepted: 09/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Geoffrey Southmayd
- Division of Cardiology Emory University School of Medicine Atlanta Georgia
| | - Azizul Hoque
- Division of Cardiology Emory University School of Medicine Atlanta Georgia
| | - Amir Kaki
- Division of Cardiology Ascension St. John Hospital Detroit Michigan
| | - Rajiv Tayal
- Division of Cardiology RWJ Barnabas Health, Newark Beth Israel Medical Center Newark New Jersey
| | - S. Tanveer Rab
- Division of Cardiology Emory University School of Medicine Atlanta Georgia
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Patel KV, Omar W, Gonzalez PE, Jessen ME, Huffman L, Kumbhani DJ, Bavry AA. Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR. Cardiol Ther 2020; 9:377-94. [PMID: 32875469 DOI: 10.1007/s40119-020-00198-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis (AS) over the last decade. The results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 and Evolut Low Risk trials demonstrated the safety and efficacy of TAVR in low-surgical-risk patients and led to the approval of TAVR for use across the risk spectrum. Heart teams around the world will now be faced with evaluating a deluge of younger, healthier patients with severe AS. Prior to the PARTNER 3 and Evolut Low Risk studies, this heterogenous patient population would have undergone surgical aortic valve replacement (SAVR). It is unlikely that TAVR will completely supplant SAVR for the treatment of severe AS in patients with a low surgical risk, as SAVR has excellent short- and long-term outcomes and years of durability data. In this review, we outline the critical role that SAVR will continue to play in the treatment of severe AS in the post-PARTNER 3/Evolut Low Risk era.
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Costa G, Bieliauskas G, Fukutomi M, Ihlemann N, Søndergaard L, De Backer O. Feasibility and safety of a fully percutaneous transcatheter aortic valve replacement program. Catheter Cardiovasc Interv 2020; 97:E418-E424. [DOI: 10.1002/ccd.29117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Giulia Costa
- The Heart Center, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | | | - Motoki Fukutomi
- The Heart Center, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Nikolaj Ihlemann
- The Heart Center, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Ole De Backer
- The Heart Center, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
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50
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Armstrong EJ, Kokkinidis DG. Unilateral Femoral Access for Transfemoral Approach in Transcatheter Aortic Valve Replacement: The Happy Medium? Cardiovasc Revasc Med 2020; 21:486-8. [PMID: 32563526 DOI: 10.1016/j.carrev.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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