Transcatheter Aortic Valve Replacement: Comparing Transfemoral, Transcarotid, and Transcaval Access

Paone, Gaetano; Eng, Marvin H.; Kabbani, Loay; Borgi, Jamil; Peterson, Edward L.; Novitsky, Brianna; Burroughs, Benjamin; Wang, Dee Dee; O’Neill, William W.; Greenbaum, Adam

doi:10.1016/j.athoracsur.2018.04.029

Cited by 38 publications

(36 citation statements)

References 23 publications

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“…However, when the right TAx approach is also precluded, selection of next available alternative access becomes critical. Transcaval and transcarotid access routes have been explored and shown promising results [20,21]. More evidence suggests that patients that underwent these peripheral TAVR approaches can benefit from the reduced invasiveness, although procedural and clinical effectiveness require further evaluation [22].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of transaxillary transcatheter aortic valve replacement using a current-generation balloon-expandable valve

Zhan¹,

Toomey²,

Ortoleva³

et al. 2020

J Cardiothorac Surg

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Background Transaxillary access (TAx) has shown promise as an excellent alternative TAVR option, but data on the Edwards SAPIEN 3 in TAx-TAVR is limited. We sought to study the safety and efficacy of TAx-TAVR using this current-generation balloon-expandable valve. Methods A retrospective study of our first 24 TAx and 20 transthoracic (TT) TAVR patients treated with the SAPIEN 3 valve was performed, and the patients’ preoperative characteristics, procedural outcomes, and clinical outcomes were compared to our first 100 transfemoral (TF) patients using the SAPIEN 3 device. Results There were no statistical differences observed for outcomes between the TAx and TF groups, despite the TAx patients having more comorbidities (STS-PROM 11.3 ± 7.6 versus 7.3 ± 5.2, p = 0.042). In addition, no significant difference was found in the fluoroscopy time and contrast amount between the two groups. The patients’ baseline characteristics were similar between the TAx and TT groups. Their procedural and clinical outcomes were comparable, but there was a trend towards lower incidence of acute kidney injury (13.0% versus 23.5%), new-onset atrial fibrillation (5.6% versus 33.3%), shorter median length of stay postoperatively (4 versus 6 days), fewer discharges to rehabilitation (16.7% versus 35.0%), and a lower rate of readmission within 30-days (8.3% versus 35.0%), all favoring TAx access. Conclusions TAx-TAVR with the SAPIEN 3 valve is a safe alternative to TF access. It offers advantages of improved recovery over TT access, and appears to be a superior alternative-access option for TAVR. TAx access could be preferred when TF access is not feasible.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of transaxillary transcatheter aortic valve replacement using a current-generation balloon-expandable valve

Zhan¹,

Toomey²,

Ortoleva³

et al. 2020

J Cardiothorac Surg

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“…In general, for patients undergoing ‘ alternative access ’ TAVR or non-transfemoral valve delivery, although index hospitalisations are longer, readmission rates have not been significantly higher, as demonstrated in a study of transfemoral, trans carotid and transcaval patients at a single, high-volume US centre 6. This finding of similar readmission rates for alternative access patients was confirmed for patients of mean age 82–85 years old with and without peripheral artery disease, the principal indication for alternative access, in the NCDR STS/ACC TVT Registry 7.…”

Section: Introductionmentioning

confidence: 93%

Identifying patients likely to be readmitted after transcatheter aortic valve replacement

Goldsweig

Aronow

2019

Heart

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Hospital readmission following transcatheter aortic valve replacement (TAVR) contributes considerably to the costs of care. Readmission rates following TAVR have been reported to be as high as 17.4% at 30 days and 53.2% at 1 year. Patient and procedural factors predict an increased likelihood of readmission including non-transfemoral access, acute and chronic kidney impairment, chronic lung disease, left ventricular systolic dysfunction, atrial fibrillation, major bleeding and prolonged index hospitalisation. Recent studies have also found the requirement for new pacemaker implantation and the severity of paravalvular aortic regurgitation and tricuspid regurgitation to be novel predictors of readmission. Post-TAVR readmission within 30 days of discharge is more likely to occur for non-cardiac than cardiac pathology, although readmission for cardiac causes, especially heart failure, predicts higher mortality than readmission for non-cardiac causes. To combat the risk of readmission and associated mortality, the routine practice of calculating and considering readmission risk should be adopted by the heart team. Furthermore, because most readmissions following TAVR occur for non-cardiac reasons, more holistic approaches to readmission prevention are necessary. Familiarity with the most common predictors and causes of readmission should guide the development of initiatives to address these conditions proactively.

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“…The survival results were also demonstrated in a series of 491 patients at a single center, with similar Kaplan-Meier survival for TF-TAVR 86%, or TC-TAVR 80%, at 1 year, P=0.104 (4).…”

Section: Clinical Resultsmentioning

confidence: 57%

Master of cardiothoracic surgery: transcaval transcatheter aortic valve replacement

Byku

Kamioka

Greenbaum

et al. 2020

Ann Cardiothorac Surg

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Transcatheter Aortic Valve Replacement: Comparing Transfemoral, Transcarotid, and Transcaval Access

Abstract: Patients unsuitable for TF TAVR treated with TC or TCav access had 30-day/in-hospital and 1-year survival similar to a contemporary cohort undergoing TF access. Avoiding surgical entry to the chest may offer procedural and intermediate-term outcomes equivalent to TF TAVR.

Cited by 38 publications

References 23 publications

Safety and efficacy of transaxillary transcatheter aortic valve replacement using a current-generation balloon-expandable valve

Safety and efficacy of transaxillary transcatheter aortic valve replacement using a current-generation balloon-expandable valve

Identifying patients likely to be readmitted after transcatheter aortic valve replacement

Master of cardiothoracic surgery: transcaval transcatheter aortic valve replacement

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