2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement

Holmes, David R.; Mack, Michael J.; Kaul, Sanjay; Agnihotri, Arvind K.; Alexander, Karen P.; Bailey, Steven R.; Calhoon, John H.; Carabello, Blasé A.; Desai, Milind Y.; Edwards, Fred H.; Francis, Gary S.; Gardner, Timothy J.; Kappetein, Arie Pieter; Linderbaum, Jane A.; Mukherjee, Chirojit; Mukherjee, Debabrata; Otto, Catherine M.; Ruiz, Carlos E.; Sacco, Ralph L.; Smith, Donnette; Thomas, James D.; Harrington, Robert A.; Bhatt, Deepak L.; Ferrari, Victor A.; Fisher, John D.; García, Mario J.; Gentile, Federico; Gilson, Michael F.; Hernandez, Adrian F.; Jacobs, Alice K.; Moliterno, David J.; Weitz, Howard H.

doi:10.1002/ccd.24351

Cited by 81 publications

(98 citation statements)

References 246 publications

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“…In patients with severe LV dysfunction, acute heart failure, and cardiogenic shock, TAVR remains an attractive option to treat severe aortic stenosis, however only after clinical stabilization 26. Currently, there is limited evidence on the prophylactic use of VA‐ECMO in critically ill patients needing a TAVR procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with pulmonary hypertension and biventricular failure would conceivably benefit from prophylactic VA‐ECMO; however this high‐risk cohort needs to be better defined to optimize the clinical outcomes 17. We recommend a multidisciplinary team approach for the care of these patients to decide among available therapies including medical management, use of balloon aortic valvuloplasty, durable LV assist devices, and palliative care 26. Ideally, these teams should comprise physicians from cardiology, interventional cardiology, cardiac surgery, critical care medicine, heart failure, palliative medicine, and anesthesiology 26, 27.…”

Section: Discussionmentioning

confidence: 99%

“…We recommend a multidisciplinary team approach for the care of these patients to decide among available therapies including medical management, use of balloon aortic valvuloplasty, durable LV assist devices, and palliative care 26. Ideally, these teams should comprise physicians from cardiology, interventional cardiology, cardiac surgery, critical care medicine, heart failure, palliative medicine, and anesthesiology 26, 27. It is important to incorporate input from palliative medicine physicians to balance the need for using sophisticated MCS devices against the use of futile, resource‐intensive therapies that may be unlikely to improve clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review

Vallabhajosyula

Patlolla

Sandhyavenu

et al. 2018

JAHA

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BackgroundThere are limited data on the use of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) or cardiopulmonary bypass (CPB) to provide hemodynamic support periprocedurally during transcatheter aortic valve replacement. This study sought to evaluate patients receiving transcatheter aortic valve replacement with concomitant use of CPB/VA‐ECMO.Methods and ResultsWe systematically reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring CPB/VA‐ECMO periprocedurally during transcatheter aortic valve replacement. Studies reporting short‐term and long‐term mortality were included. Given the significant methodological and statistical differences between published studies, meta‐analysis of the association of CPB/VA‐ECMO with mortality was not performed. Of the 537 studies identified, 9 studies representing 5191 patients met our inclusion criteria. Median ages were between 75 and 87 years with 33% to 75% male patients. Where reported, the Edwards SAPIEN™ transcatheter heart valve was the most frequently used. A total of 203 (3.9%) patients received periprocedural hemodynamic support with CPB/VA‐ECMO. Common indications for CPB/VA‐ECMO included left ventricular or aortic annular rupture, rapid hemodynamic deterioration, aortic regurgitation, cardiac arrest, and left main coronary artery obstruction. The use of CPB/VA‐ECMO was predominantly an emergent strategy and was used for durations of 1 to 2 hours. Short‐term mortality (in‐hospital and 30‐day) was 29.8%, and 1‐year mortality was 52.4%. Major complications such as bleeding, vascular injury, tamponade, stroke, and renal failure were noted in 10% to 50% of patients.Conclusions CPB/VA‐ECMO was used in 4% in the early experience of patients undergoing transcatheter aortic valve replacement, most commonly for periprocedural complications. There are limited data on preprocedural planned use of VA‐ECMO, and the characteristics of this population remain poorly defined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review

Vallabhajosyula

Patlolla

Sandhyavenu

et al. 2018

JAHA

Self Cite

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“…The appropriate evaluation and selection of patients for consideration of TAVI is crucial for optimal outcomes and should be undertaken by a 'Heart Team' consisting of interventional cardiologists, imaging cardiologists, cardiac surgeons, cardiac anaesthetists and general physicians with experience in the care of elderly patients (25). As outlined in Table I A recent comparison has suggested that the STS score may be the best of the currently available systems at predicting 30-day mortality (28); however, they have generally been shown to have suboptimal predictive value for mortality after TAVI (29).…”

Section: Current Indicationsmentioning

confidence: 99%

Indications for transcatheter aortic valve implantation – now and next?

Ruparelia

Prendergast

2015

Minimally Invasive Therapy & Allied Technologies

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Aortic stenosis (AS) is the most common valvular pathology and its prevalence is expected to increase rapidly in coming decades as a consequence of the increasingly elderly population. Without treatment, severe symptomatic AS has a very poor prognosis with a mortality of 50% at two years. Whilst surgical aortic valve replacement is the gold standard treatment, a significant minority of patients are deemed inoperable and declined surgery due to prohibitively high risk. The advent of transcatheter aortic valve implantation (TAVI) has revolutionised their treatment. In this review, we discuss current indications for TAVI, other applications of this technology and future indications.

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“…14,16 The ACCP valvular heart disease guidelines recommend using 50 to 100 mg aspirin daily plus 75 mg clopidogrel daily over VKA therapy and no antiplatelet therapy in the first 3 months for patients undergoing TAVR (grade 2C recommendation). 14 The ACCF/AATS/SCAI/STS consensus statement on TAVR recommends, under the anesthetic considerations section, that heparin be started after insertion of the sheath into the vasculature and titrated to achieve an activated clotting time (ACT) of .…”

Section: Guidelines For Tavrmentioning

confidence: 99%

A Review of Antithrombotic Therapy for Transcatheter Aortic Valve Replacement

Davis¹,

Friedman²,

Baker³

2013

Postgraduate Medicine

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Aortic stenosis (AS) is a common valvular pathological finding in older adults. A latent period followed by rapid progression after the onset of symptoms can result in a high rate of death if left untreated. Aortic valve replacement (AVR) remains the standard of care for patients with severe symptomatic AS; however, due to comorbidities and age, patients may be ineligible for surgical AVR. Transcatheter AVR (TAVR) is an alternative treatment for patients with severe symptomatic AS for whom surgery is not an option. The most recent guidelines and consensus statement discussing TAVR support the use of antithrombotic therapy during and after TAVR procedures to prevent thrombotic complications. Intravenous unfractionated heparin titrated to target activated clotting times during the procedure and dual antiplatelet therapy before and after TAVR with aspirin and clopidogrel may be used. However, it is unclear which antithrombotic regimen may provide optimal protection for early and late thrombotic events in patients who undergo TAVR. This review evaluates the current guidelines, trials, and registry data discussing antithrombotic regimens for TAVR.

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2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement

Cited by 81 publications

References 246 publications

Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review

Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review

Indications for transcatheter aortic valve implantation – now and next?

A Review of Antithrombotic Therapy for Transcatheter Aortic Valve Replacement

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