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Zahr F, Song HK, Chadderdon S, Gada H, Mumtaz M, Byrne T, Kirshner M, Sharma S, Kodali S, George I, Merhi W, Yarboro L, Sorajja P, Bapat V, Bajwa T, Weiss E, Thaden JJ, Gearhart E, Lim S, Reardon M, Adams D, Mack M, Leon MB. 1-Year Outcomes Following Transfemoral Transseptal Transcatheter Mitral Valve Replacement: Intrepid TMVR Early Feasibility Study Results. JACC Cardiovasc Interv 2023; 16:2868-2879. [PMID: 37902145 DOI: 10.1016/j.jcin.2023.10.001] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND High surgical risk may preclude mitral valve replacement in many patients. Transcatheter mitral valve replacement (TMVR) using transfemoral transseptal access is a novel technology for the treatment of mitral regurgitation (MR) in high-risk surgical patients. OBJECTIVES This analysis evaluates 30-day and 1-year outcomes of the Intrepid TMVR Early Feasibility Study in patients with ≥moderate-severe MR. METHODS The Intrepid TMVR Early Feasibility Study is a multicenter, prospective, single-arm study. Clinical events were adjudicated by a clinical events committee; endpoints were defined according to Mitral Valve Academic Research Consortium criteria. RESULTS A total of 33 patients, enrolled at 9 U.S. sites between February 2020 and August 2022, were included. The median age was 80 years, 63.6% of patients were men, and mean Society of Thoracic Surgeons Predicted Risk of Mortality for mitral valve replacement was 5.3%. Thirty-one (93.9%) patients were successfully implanted. Median postprocedural hospitalization length of stay was 5 days, and 87.9% of patients were discharged to home. At 30 days, there were no deaths or strokes, 8 (24.2%) patients had major vascular complications and none required surgical intervention, there were 4 cases of venous thromboembolism all successfully treated without sequelae, and 1 patient had mitral valve reintervention for severe left ventricular outflow tract obstruction. At 1 year, the Kaplan-Meier all-cause mortality rate was 6.7%, echocardiography showed ≤mild valvular MR, there was no/trace paravalvular leak in all patients, median mitral valve mean gradient was 4.6 mm Hg (Q1-Q3: 3.9-5.3 mm Hg), and 91.7% of survivors were in NYHA functional class I/II with a median 11.4-point improvement in Kansas City Cardiomyopathy Questionnaire overall summary scores. CONCLUSIONS The early benefits of the Intrepid transfemoral transseptal TMVR system were maintained up to 1 year with low mortality, low reintervention, and near complete elimination of MR, demonstrating a favorable safety profile and durable valve function.
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Affiliation(s)
- Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA.
| | - Howard K Song
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Hemal Gada
- UPMC Pinnacle Harrisburg Campus, Harrisburg, Pennsylvania, USA
| | - Mubashir Mumtaz
- UPMC Pinnacle Harrisburg Campus, Harrisburg, Pennsylvania, USA
| | - Timothy Byrne
- Abrazo Arizona Heart Hospital, Phoenix, Arizona, USA
| | | | - Samin Sharma
- Mount Sinai Medical Center, New York, New York, USA
| | - Susheel Kodali
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - William Merhi
- Spectrum Health Hospitals, Grand Rapids, Michigan, USA
| | - Leora Yarboro
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak Bapat
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Tanvir Bajwa
- Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Eric Weiss
- Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | - Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - David Adams
- Mount Sinai Medical Center, New York, New York, USA
| | - Michael Mack
- Baylor Scott and White Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
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Tawfik A, Abd El-Fattah AM, El-Sisi H, Kamal E, Ebada HA. Nasal Spine of the Frontal Bone: A Consistent Landmark for Safe Outside-In Frontal Drill-Out. Am J Rhinol Allergy 2022; 36:773-779. [PMID: 35769036 DOI: 10.1177/19458924221111831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/15/2022]
Abstract
BACKGROUND Outside-in frontal drill out entails drilling the frontal sinus floor in the midline before identifying and dissecting the frontal recesses. It is a more direct approach, especially in revision surgery or cases with challenging anatomy. OBJECTIVES The aim of this study was to highlight the anatomical and surgical concepts for easy and safe outside-in frontal drill out by a preclinical anatomic study on cadaveric heads. In addition, to review our experience with this approach over a 5-year period for challenging frontal sinus pathologies. METHODS The study included 2 sectors; a preclinical study, in which 5 cadaveric heads were dissected and studied to identify and standardize the anatomical landmarks of this approach. This was followed by a clinical case series which included 22 patients with challenging frontal sinus pathologies that were treated with this proposed approach. RESULTS We concluded from the anatomic study that the nasal spine of the frontal bone (NSFB) and its anatomical orientation in relation to the nasal branch of the anterior ethmoidal artery (NBAEA) is a consistent landmark that enables the surgeon to identify the correct coronal trajectory of drilling to avoid injury of the cribriform and the skull base. The clinical case series included 22 patients that were successfully treated with the proposed approach. No intraoperative nor postoperative complications were reported in this study. Long-term follow-up showed that the frontal neo-ostium was patent in all cases (n = 22). CONCLUSION Outside-in frontal drill-out is a safe and easy approach; especially in challenging frontal sinus pathologies; using the NSFB and its anatomical coronal orientation to the NBAEA as a consistent landmark, anterior to the skull base. This approach offers early, safe, and direct bone removal without the need for initial identification and dissection of the frontal recess.
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Affiliation(s)
- Ali Tawfik
- Department of Otorhinolaryngology, 68780Mansoura University, Egypt
| | | | - Hossam El-Sisi
- Department of Otorhinolaryngology, 68780Mansoura University, Egypt
| | - Elsharawy Kamal
- Department of Otorhinolaryngology, 68780Mansoura University, Egypt
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Biasco L, Ferrari E, Pedrazzini G, Faletra F, Moccetti T, Petracca F, Moccetti M. Access Sites for TAVI: Patient Selection Criteria, Technical Aspects, and Outcomes. Front Cardiovasc Med 2018; 5:88. [PMID: 30065928 PMCID: PMC6056625 DOI: 10.3389/fcvm.2018.00088] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [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: 04/16/2018] [Accepted: 06/19/2018] [Indexed: 12/02/2022] Open
Abstract
During the last ten years, transcatheter aortic valve implantation (TAVI) has become a reliable and valid alternative treatment for elderly patients with severe symptomatic aortic valve stenosis requiring valve replacement and being at high or intermediate surgical risk. While common femoral arteries are the access site of choice in the vast majority of TAVI patients, in up to 15–20% of TAVI candidates this route might be precluded due to the presence of diffuse atherosclerotic disease, tortuosity or small vessel diameter. Therefore, in order to achieve an antegrade or retrograde implant, several alterative access routes have been described, namely trans-axillary, trans-aortic, trans-apical, trans-carotid, trans-septal, and trans-caval. The aim of this paper is to give a concise overview on vascular access sites for TAVI, with a particular focus on patient's selection criteria, imaging, technical aspects, and clinical outcome.
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Affiliation(s)
- Luigi Biasco
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Enrico Ferrari
- Division of Cardiovascular Surgery, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Francesco Faletra
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Francesco Petracca
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Marco Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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Misenheimer JA, Poommipanit P, Amin Z. Retrograde percutaneous repair of aortic coarctation utilizing trans-septal puncture in patients with complex anatomy. Catheter Cardiovasc Interv 2016; 87:446-50. [PMID: 26508264 DOI: 10.1002/ccd.26165] [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: 12/02/2014] [Accepted: 07/27/2015] [Indexed: 11/06/2022]
Abstract
Coarctation of the aorta (COA) is one of the more common congenital anomalies, occurring in four in ten thousand live births and accounting for five to eight percent of all congenital heart defects. COA lesions can be challenging to treat percutaneously, especially if complex vascular anatomy is a barrier to crossing the lesion. We present two cases of COA that utilized a trans-septal approach to cross the lesion in anterograde fashion, subsequently facilitating retrograde stenting of the lesions after snaring and externalizing the wire. In both cases, the trans-septal approach was employed because traditional femoral and radial approaches failed due to complex anatomy, and the trans-septal approach allowed for effective intervention without the need for surgery.
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Affiliation(s)
- Jacob A Misenheimer
- Division of Congenital and Structural Heart Disease, Georgia Regents University, Augusta, Georgia
| | - Paul Poommipanit
- Division of Congenital and Structural Heart Disease, Georgia Regents University, Augusta, Georgia
| | - Zahid Amin
- Division of Congenital and Structural Heart Disease, Georgia Regents University, Augusta, Georgia
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