Surgical cut‐down or percutaneous access—which is best for less vascular access complications in transfemoral TAVI?

Spitzer, Stefan G.; Wilbring, Manuel; Alexiou, Konstantin; Stumpf, Julian; Kappert, Utz; Matschke, Klaus

doi:10.1002/ccd.26361

Cited by 22 publications

(26 citation statements)

References 19 publications

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“…Tortuosity was graded as none, mild (30‐60°), moderate (60‐90°), or severe (>90°). MDCT calcification was graded as none, mild (some calcification), moderate (the arterial course can be seen without contrast dye injection), or severe (heavily calcified iliofemoral arteries) . The sheath to femoral artery ratio (SFAR) was defined as the ratio between the sheath outer diameter and the femoral artery MLD, while the unexpanded sheath diameter was used for the calculation…”

Section: Methodsmentioning

confidence: 99%

The novel echo‐guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation

Honda

Araki

Yamawaki

et al. 2017

J Interven Cardiology

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Section: Methodsmentioning

confidence: 99%

The novel echo‐guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation

Honda

Araki

Yamawaki

et al. 2017

J Interven Cardiology

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“…47,48 While greater sheath-to-artery diameter ratio 49,50 and sheath-to-artery area ratio 49 independently predict incident vascular complications, the latter metric appears to be more sensitive. The subclavian approach is safe and feasible with procedural success rates, safety end points, including major vascular complications, and life-threatening bleeding similar to those seen with TF-TAVR.…”

Section: Predictorsmentioning

confidence: 99%

“…54 A propensity-matched comparison of open surgical versus percutaneous access for TF-TAVR suggested no difference in the incidence of vascular complications but shorter length of stay with the latter. 50 Vascular closure. There are limited and conflicting data from studies comparing the Prostar XL and ProGlide hemostasis devices in the setting of TAVR.…”

Section: Preventionmentioning

confidence: 99%

Vascular complications associated with transcatheter aortic valve replacement

et al. 2017

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Transcatheter aortic valve replacement (TAVR) is now an accepted pathway for aortic valve replacement for patients who are at prohibitive, severe and intermediate risk for traditional aortic valve surgery. However, with this rising uptrend and adaptation of this new technology, vascular complications and their management remain an Achilles heel for percutaneous aortic valve replacement. The vascular complications are an independent predictor of mortality for patients undergoing TAVR. Early recognition of these complications and appropriate management is paramount. In this article, we review the most commonly encountered vascular complications associated with currently approved TAVR devices and their optimal percutaneous management techniques.

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“…37 Percutaneous approach has shown similar in-hospital or 30-day mortality rates compared with surgical cutdown approach in several reports. [36][37][38][39][40][41] Vascular complications were also compared between the two approaches, demonstrating varying incidence rates across studies ranging from 2.4% to 27.1% for major vascular complications when the percutaneous approach is used. 40 The wide variation is due to discrepancy regarding definition of complications, the type and the generation of the transcatheter heart valve, and the study periods.…”

Section: Percutaneous Approachmentioning

confidence: 99%

Minimalist approach for transcatheter aortic valve replacement

Dallan¹,

Ichibori²,

Attizzani³

2019

J Transcat Intervent

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Transcatheter aortic valve replacement became a routine interventional procedure worldwide, together with improvements in valve technology and optimized implant techniques. The concept of minimalist approach became relevant, aiming at optimal technical implant, fewer perioperative comorbidities, and consequently faster recovery and less associated risks. Compared with surgical aortic valve replacement, reduction of hospital and intensive care unit stay and fewer rates of procedural complications offset the high costs of transcatheter aortic valve replacement valves. The principles of the minimalist approach consist on top performance by experienced structural interventionists, a complete transcatheter basis under local anesthesia and conscious sedation, together with bedside transthoracic echocardiography to access hemodynamic features. It is necessary to customize transcatheter aortic valve replacement optimal procedure by revising how to simplify each aspect of the patient's care process, without losing focus on safety and best outcomes based on individualized patient characteristics, center's expertise, and multidisciplinary care. This review aimed to summarize the current evidence for a minimalist approach to transfemoral transcatheter aortic valve replacement and provide information for its safe and successful implementation and customization.Keywords: Transcatheter aortic valve replacement; Aortic valve/surgery; Aortic valve stenosis; Heart valve prosthesis implantation/methods resumo -O implante transcateter de válvula aórtica tornou-se uma intervenção de rotina em todo o mundo, acompanhando as melhorias na tecnologia das válvulas e a otimização das técnicas de implante. O conceito de abordagem minimalista tornou-se relevante, visando obter um implante tecnicamente ideal, menos comorbidades perioperatórias e, consequentemente, recuperação mais rápida e com menos riscos associados. Em comparação à cirurgia de troca da válvula aórtica, a redução no tempo de hospitalização e na unidade de terapia intensiva, e a menor incidência de complicações do procedimento acabam por compensar os custos mais altos das válvulas para o implante transcateter de válvula aórtica. Os princípios da abordagem minimalista consistem em desempenho superior de intervencionistas estruturais experientes, uma base estrutural completa sob anestesia local e sedação consciente, juntamente da ecocardiografia transtorácica à beira do leito, para avaliar características hemodinâmicas. É necessário customizar um procedimento ideal do implante transcateter de válvula aórtica, procurando simplificar cada um dos aspectos da atenção ao paciente, sem perder o foco na segurança e na obtenção dos melhores desfechos, com base nas características individuais na experiência do centro e no atendimento multidisciplinar. Esta revisão teve como objetivo sintetizar as evidências atuais para uma abordagem minimalista do implante transcateter de válvula aórtica transfemoral, e fornecer informações para garantir a segurança e o sucesso da implementação e customi...

show abstract

Surgical cut‐down or percutaneous access—which is best for less vascular access complications in transfemoral TAVI?

Cited by 22 publications

References 19 publications

The novel echo‐guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation

The novel echo‐guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation

Vascular complications associated with transcatheter aortic valve replacement

Minimalist approach for transcatheter aortic valve replacement

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