Transapical aortic valve replacement is a safe option in patients with poor left ventricular ejection fraction: results from the Italian Transcatheter Balloon-Expandable Registry (ITER)†

D’Onofrio, Augusto; Salizzoni, Stefano; Filippini, Claudia; Agrifoglio, Marco; Alfieri, Ottavio; Chieffo, Alaide; Tarantini, Giuseppe; Gabbieri, Davide; Savini, Carlo; Immè, Sebastiano; Ribichini, Flavio; Cugola, Diego; Raviola, Eliana; Loi, Bruno; Pompei, Esmeralda; Cappai, Antioco; Cassese, Mauro; Luzi, Giampaolo; Aiello, Marco; Santini, Francesco; Rinaldi, Mauro; Gerosa, Gino

doi:10.1093/ejcts/ezx227

Cited by 10 publications

(7 citation statements)

References 23 publications

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“…Postprocedural atrioventricular block requiring a PPM implantation is the main cardiac complication, which has been widely investigated in the currently published researches, 6 , 10 , 20 , 21 with, contrary to our results, an incidence of 13.4% according to a recently published systematic review involving 11,599 patients. 8 Previous published research has consistently found that procedure-related parameters such as the implantation of a larger prosthesis into a smaller annulus and a deep valve implantation, but also patient-related ones included a pre-existing right bundle block, patient age >75 years, male gender, chronic AF, perioperative bradycardia and high calcification load of the native valve are among the main risk factors for postprocedural heart block.…”

Section: Discussioncontrasting

confidence: 99%

“…It is estimated that during the 3-year period (2011–2014), more than 26,000 TAVI procedures had been performed at 348 centers in the USA with satisfactory patient outcomes. 5 However, despite the high safety and effectiveness of TAVI procedure in appropriately selected patients groups, 6 this therapeutic option has several periprocedural complications, including stroke, bleeding, vascular complications, acute kidney injury, requirement for permanent pacemaker (PPM) implantation, myocardial infarction, valve malposition, paravalvular leak and heart block. 7 , 8 In the currently available published research, several patient and technical-related factors have been associated with postprocedural complications such as advanced age, female gender, diabetes mellitus, poor left ventricular ejection fraction, peripheral arterial disease, access route, size of the delivery system, history of stroke, prior and/or a new-onset atrial fibrillation (NOAF), baseline severe aortic regurgitation, severity of calcifications on the valve and the aortic arch.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, this literature deficit is more apparent among those receiving TAVI through the transapical access, a patient subgroup with poorer outcome, compared with the most widely used and first choice approach, the transfemoral one. 6 , 9 , 14 The purpose of the present study was to investigate the periprocedural parameters associated with early cardiac complications in patients after TAVI procedure through the transapical approach. Our study intents to contribute new data to TAVI complications prognosis limited body of knowledge in this specific transapically treated patients’ subgroup.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach

Patris

Giakoumidakis

Argiriou

et al. 2018

POR

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PurposeTo estimate the incidence of postprocedural early cardiac complications among patients undergoing transcatheter aortic valve implantation, through transapical approach (TA-TAVI), and to identify factors independently associated with the occurrence of them.Patients and methodsA retrospective cohort study of 90 patients, who had undergone TA-TAVI in a tertiary hospital of Liverpool, UK, during a 5-year period (September 2008–October 2013), was conducted. Data on patient demographics, periprocedural characteristics and cardiac complications presented within 30-day post TA-TAVI were collected, retrospectively, using the hospital’s electronic database.ResultsThe overall 30-day incidence of cardiac complications was estimated at 18.9% (n=17/90). The rate of new onset of atrial fibrillation (AF), atrioventricular block requiring permanent pacemaker implantation, shockable cardiac arrest rhythm and cardiac tamponade was 11.1%, 3.3%, 2.2% and 2.2%, respectively. Bivariate analysis found that absence of preoperative AF (p=0.01), receiving of oral inotropes preprocedurally (p=0.01), intravenous inotropic support postprocedurally (p=0.01) and requirement for postprocedural tracheal intubation (p=0.001) were the main factors associated with increased probability for patient cardiac morbidity.ConclusionIt seems that patients with absence of AF and oral inotropic support preprocedurally and those with post TA-TAVI mechanical ventilatory and intravenous inotropic support have greater probability to develop cardiac complications. This knowledge allows the early identification of high-risk patients and supports clinicians to apply both preventive and therapeutic interventions for the optimum patient management and care. In addition, administrators could allocate the health care system resources effectively.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach

Patris

Giakoumidakis

Argiriou

et al. 2018

POR

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“…The authors found a significant increase of ≥10% in LVEF at discharge, which was persistent at 1-year follow-up. 10 Theoretically, it can be assumed that manipulation of the LV apex will worsen the functioning of an already suffering LV myocardium. Findings from this study, however, does not support this notion.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Function Recovery After Transapical TAVR in Patients With Previous Coronary Artery Bypass Graft Surgery

Okoh

Sossou

Kang

et al. 2019

Innovations�(Phila)

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Objective The transapical (TA) approach is an alternative access technique for transcatheter aortic valve replacement (TAVR) in patients with symptomatic aortic valve stenosis. The impact of prior coronary artery bypass graft (CABG) surgery and how it affects left ventricular function recovery is not well defined. Methods Patients who had TAVR at a single center between June 2012 and December 2016 were reviewed. High-risk patients who underwent the procedure via a TA approach were divided into 2 groups based on their history of CABG surgery. Postoperative outcomes were compared between groups. CABG/TA-TAVR patients were subdivided into 2 per baseline left ventricular ejection fraction (LVEF) <50%. The changes in LVEF and valve function at follow-up (1 to 12 months) were analyzed using paired t-tests. Results Of 923 cases in total, 183 (19.8%) were performed via a TA approach. The mean ± SD Society of Thoracic Surgeons risk score of TA patients was 10.2 ± 4.6. Forty-nine (27%) had a surgical history of CABG. Overall all-cause mortality rates at 30 days, 1 year, and 2 years were similar for both groups ( P = 0.59, P = 0.64, P = 0.78). Subgrouping of CABG-TAVR patients ( n = 49) identified 24 patients (49%) with LVEF ≥50% vs. 25 (51%) with LVEF <50%. At 1-year follow-up, significant improvements in LVEF (low LVEF group) and valve function for both groups were observed. LVEF ≥50% group (LVEF: ∆: −3%, P = 0.878; aortic valve area [AVA]: ∆: 1.3 cm2, P < 0.001; mean gradient: ∆: −38 mmHg, P < 0.001); LVEF <50% group (LVEF: ∆: 10%, P = 0.01; AVA: ∆: 1.3 cm2, P < 0.001; MG: ∆: −31 mmHg, P < 0.001). Conclusions TA-TAVR can be safely performed with acceptable postoperative outcomes in patients with a history of CABG surgery. In those with reduced EF, significant improvements in LV and valve functions are seen at 1-year follow-up.

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“…This led to the belief that the transapical approach was unfit for low-ejection fraction patients. Recently, however, favourable outcomes have been reported even in this particular subsetting [17][18][19]. Left anterior descending (LAD) coronary artery injury can also occur suturing the left ventricular apex; precise identification of the LAD during the procedure by means of direct vision is mandatory to prevent this complication.…”

Section: Transapical Tavrmentioning

confidence: 99%

Left Ventricular Apex: A “Minimally Invasive Motorway” for Safe Cardiovascular Procedures

Agostinelli

Gallingani

Maestri

et al. 2021

JCM

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Since the advent of TAVR (transcatheter aortic valve replacement), the transapical surgical approach has been affirmed as a safe and effective alternative access for patients with unsuitable peripheral arteries. With the improvement of devices for transfemoral approach and the development of other alternative accesses, the number of transapical procedures has decreased significantly worldwide. The left ventricular apex, however, has proved to be a safe and valid alternative access for various other structural heart procedures such as mitral valve repair, mitral valve-in-valve or valve-in-ring replacement, transcatheter mitral valve replacement (TMVR), transcatheter mitral paravalvular leak repair, and thoracic aorta endovascular repair (TEVAR). We review the literature and our experience of various hybrid transcatheter structural heart procedures using the transapical surgical approach and discuss pros and cons.

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Transapical aortic valve replacement is a safe option in patients with poor left ventricular ejection fraction: results from the Italian Transcatheter Balloon-Expandable Registry (ITER)†

Cited by 10 publications

References 23 publications

Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach

Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach

Left Ventricular Function Recovery After Transapical TAVR in Patients With Previous Coronary Artery Bypass Graft Surgery

Left Ventricular Apex: A “Minimally Invasive Motorway” for Safe Cardiovascular Procedures

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