Transcarotid Versus Subclavian/Axillary Access for Transcatheter Aortic Valve Replacement With SAPIEN 3

Kirker, Eric; Korngold, Ethan C; Hodson, Robert W.; Jones, Brandon; McKay, Raymond G.; Cheema, Mohiuddin; Heimansohn, David; Moainie, Sina L.; Hermiller, James; Chatriwalla, Adnan; Saxon, John; Allen, Keith B.

doi:10.1016/j.athoracsur.2020.05.141

Cited by 62 publications

(35 citation statements)

References 15 publications

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“…Hence, Beve and Auffret concluded significantly higher PPI rates after nonfemoral, transarterial TAVI (17%) compared with transthoracic group (4%). 18 In the recent relevant studies that reported PPI after nonfemoral, transarterial TAVI using SAPIEN 3 and SAPIEN 3 Ultra, 11,13 we see rates that are considerably higher (12, 11, 9%) than contemporary PPI rates, using SAPIEN 3, such as in PARTNER 3 trial (6.6% after TF-TAVI) 25 and in our study (7.4%) as well.…”

Section: Transapical Versus Nontransfemoral Transvascular Optionssupporting

confidence: 68%

Transcatheter Aortic Valve Implantation in Patients Who Cannot Undergo Transfemoral Access

Useini

Beluli

Christ

et al. 2021

Thorac Cardiovasc Surg

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Introduction Though transfemoral (TF) access has emerged as a gold standard access for patients with aortic stenosis who undergo transcatheter aortic valve implantation (TAVI), there has been no study that has characterized patients who cannot undergo TF access in detail. We aim to evaluate the contraindications for TF access, their incidence, classify them, and provide the outcomes of patients who failed to be TF candidates. Methods From 925 patients who underwent TAVI between February 2014 and May 2020 at our heart center, 130 patients failed to be TF candidates and underwent transapical-transcatheter aortic valve implantation (TA-TAVI). In this study, we included all those patients who failed to be TF candidates and underwent TA-TAVI using the third-generation balloon expandable valve (Edwards SAPIEN 3 valve [S3]) (116 patients; STS score 6.07 ± 4.4; age 79.4 ± 7). Results The incidence of patients unsuitable for TF access at our heart center was 14%. We classified this TAVI population into absolute contraindication for TF access n = 84 (72.5%) and increased interventional risk for TF access n = 32 (27.5%). After TA-TAVI of this specific population using S3, the in-hospital mortality and stroke were 1.7 and 1.7%, respectively. The vascular injury rate was 1.7%. We registered no paravalvular leakage ≥2. The pacemaker rate was 7.4%. The mean transvalvular pressure gradient was 8.7 mm Hg. Conclusion The incidence of patients who cannot undergo TF access or who are at high interventional risk is considerably high. TA-TAVI, supported with sufficient interventional experience and appropriate valve system, represents an excellent alternative for patients with distinct vasculopathy.

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Section: Transapical Versus Nontransfemoral Transvascular Optionssupporting

confidence: 68%

Transcatheter Aortic Valve Implantation in Patients Who Cannot Undergo Transfemoral Access

Useini

Beluli

Christ

et al. 2021

Thorac Cardiovasc Surg

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“…matching, and noted that TC access was associated with similar 30-day mortality but a significantly lower risk of stroke, shorter procedure and fluoroscopy time, lower contrast volume, shorter intensive care unit and hospital length of stay, and more patients discharged home. 13 In the absence of randomized trials, these serve as evidence that TC access has the potential to be the primary alternative approach.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13] TC access is increasingly considered, when an alternative TAVR approach appears necessary. 13 However, evidence is still limited with regard to the comparison of TC access to other alternative TAVR approaches. Comparing the outcomes of TAVRs using the TC and TF access routes could help inform the preferred approach for alternative access.…”

Section: Introductionmentioning

confidence: 99%

“…TC access shows promise as an attractive alternative approach for its being a peripheral route with direct access, shortened distances to the aortic root, and more accurate valve positioning relative to TF 6 . Since the first case report in 2010, 7 there has been an increasing number of reports in the literature on the safety and efficacy of TC‐TAVR 8‐13 . TC access is increasingly considered, when an alternative TAVR approach appears necessary 13 .…”

Section: Introductionmentioning

confidence: 99%

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A meta‐analysis of transcarotid versus transfemoral transcatheter aortic valve replacement

McGrath

Kawabori

Wessler

et al. 2021

Catheter Cardiovasc Interv

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Background Carotid access has shown promise as an excellent delivery route for transcatheter aortic valve replacement (TAVR). We aimed to compare outcomes of transcarotid (TC) and transfemoral (TF) TAVR by conducting a search and analysis of the best evidence in the literature to shed light on its safety and effectiveness. Methods The PubMed/MEDLINE, Embase, and Cochrane library from inception to July 2020 were searched to identify articles reporting comparative data on TC versus TF approaches for TAVR. Patients' baseline characteristics and clinical outcomes were extracted from the articles and pooled for analysis. Results Five studies, including a total of 2470 patients, were included in the study with 1859 patients in the TF group and 611 patients in the TC group. The TC group had higher prevalence of peripheral vascular disease, while the patients in the TF group was older. Meta‐analysis revealed that there was no significant differences between the two groups with regard to 30‐day mortality (p = 0.09), stroke (p = 0.28), new dialysis (p = 0.58), major bleeding (p = 0.69), or pacemaker implantation (p = 0.44). The TF group had a higher incidence of vascular complications (3.9% vs. 2.3%; OR 2.22; 95% CI [1.13, 4.38]; p = 0.02). Conclusions Compared with the TF approach, TC‐TAVR is associated with comparable procedural and clinical outcomes. Our analysis found a lower rate of vascular complication in TC access compared with TF access. This supports consideration of such an alternative access when there are concerns over the feasibility of TF access.

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“…In contrast, the most recent studies of other nontransfemoral approaches in usual TAVR populations using the most recently developed valves with very fine delivery systems, such as SAPIEN 3 and SAPIEN 3 Ultra, have shown mortality rates ranging between 4.3% and 5.2%, and stroke rates between 4.2% and 7.4%. 13 Even though our cohort does not necessarily reflect the broader population of patients who cannot undergo other non-TF approaches, the interventional risk with other nontransfemoral approaches in patients with diverse AP remains high, as recent studies have reported considerably high rates of vascular injuries (between 4.8% and 6.9%). 14 Lastly, the invasiveness of a procedure depends not only on whether it has been performed percutaneously.…”

Section: Discussionmentioning

confidence: 99%

Impact of diverse aortic pathologies on outcomes after transapical transcatheter aortic valve replacement

Useini

Beluli

Christ

et al. 2021

Journal of Cardiac Surgery

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Objectives: Some patients who undergo transcatheter aortic valve replacement (TAVR) have a concomitant diverse aortic pathologies (AP). They are usually considered high-risk candidates for the procedure and require further assessment to determine the best vascular approach. The impact of these AP on TAVR is not well known as the information is scarce. We aimed to evaluate midterm clinical impact of different AP after transapical (TA)-TAVR.Methods: Twenty patients with atherosclerotic/occluding aortic diseases (A/OAD) (porcelain aorta, Leriche Syndrome, penetrating aortic ulcer, and aortic thrombus), 24 patients with aortic morphologic diseases (AMD) (thoracic/abdominal aortic aneurysms, aortic kinking, aortic type B dissection, aortic elongation/tortuosity, and previous aortic intervention), and 11 patients with combined aortic diseases (CAD) underwent TA-TAVR treatment between January 2011 and November 2019 at our center. We conducted up to 5-years clinical follow-up.Results: All patients were classified in the heart team as a high interventional risk.

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Transcarotid Versus Subclavian/Axillary Access for Transcatheter Aortic Valve Replacement With SAPIEN 3

Cited by 62 publications

References 15 publications

Transcatheter Aortic Valve Implantation in Patients Who Cannot Undergo Transfemoral Access

Transcatheter Aortic Valve Implantation in Patients Who Cannot Undergo Transfemoral Access

A meta‐analysis of transcarotid versus transfemoral transcatheter aortic valve replacement

Impact of diverse aortic pathologies on outcomes after transapical transcatheter aortic valve replacement

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