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Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies

The snare-assisted technique has been described to facilitate transcatheter aortic valve replacement (TAVR) delivery system advancement in complex aortic anatomies. However, the evidence is limited to case reports. To evaluate the safety profile of the snare-facilitated approach and its impact on se...

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Autores principales: Yao, Yi-Jun, Zhao, Zhen-Gang, Wang, Xi, Peng, Yong, Wei, Jia-Fu, He, Sen, Li, Yi-Jian, He, Jing-Jing, Zhu, Zhong-Kai, Feng, Yuan, Chen, Mao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10420027/
https://www.ncbi.nlm.nih.gov/pubmed/37568469
http://dx.doi.org/10.3390/jcm12155067
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author Yao, Yi-Jun
Zhao, Zhen-Gang
Wang, Xi
Peng, Yong
Wei, Jia-Fu
He, Sen
Li, Yi-Jian
He, Jing-Jing
Zhu, Zhong-Kai
Feng, Yuan
Chen, Mao
author_facet Yao, Yi-Jun
Zhao, Zhen-Gang
Wang, Xi
Peng, Yong
Wei, Jia-Fu
He, Sen
Li, Yi-Jian
He, Jing-Jing
Zhu, Zhong-Kai
Feng, Yuan
Chen, Mao
author_sort Yao, Yi-Jun
collection PubMed
description The snare-assisted technique has been described to facilitate transcatheter aortic valve replacement (TAVR) delivery system advancement in complex aortic anatomies. However, the evidence is limited to case reports. To evaluate the safety profile of the snare-facilitated approach and its impact on self-expanding (SE) TAVR outcomes, we collected consecutive patients who underwent transfemoral SE-TAVR for aortic stenosis, using propensity score matching (PSM) separately in tricuspid and type-0 and type-1 bicuspid aortic valve morphology between the snare and non-snare groups. In 766 patients, despite the snare group having significantly larger annulus angulation and maximal ascending aortic diameter, both groups achieved comparable 30-day device success rates, regardless of first-generation or new-generation valve use. After PSM, the snare group had a significantly lower new permanent pacemaker implantation rate among 193 type-0 patients (3.3% vs. 18.3%, p = 0.01). The ipsilateral group used new-generation valves less frequently (23.0% vs. 75.4%, p < 0.001), but there were no significant inter-group differences in procedure-related events, except for a lower incidence of PVL ≥ mild in the ipsilateral group (14.9% vs. 32.3%, p = 0.01). In conclusion, the snare-assisted technique appears useful in SE-TAVR with angulated aortic root anatomy, and the benefits were comparable between ipsilateral and contralateral snare techniques.
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spelling pubmed-104200272023-08-12 Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies Yao, Yi-Jun Zhao, Zhen-Gang Wang, Xi Peng, Yong Wei, Jia-Fu He, Sen Li, Yi-Jian He, Jing-Jing Zhu, Zhong-Kai Feng, Yuan Chen, Mao J Clin Med Article The snare-assisted technique has been described to facilitate transcatheter aortic valve replacement (TAVR) delivery system advancement in complex aortic anatomies. However, the evidence is limited to case reports. To evaluate the safety profile of the snare-facilitated approach and its impact on self-expanding (SE) TAVR outcomes, we collected consecutive patients who underwent transfemoral SE-TAVR for aortic stenosis, using propensity score matching (PSM) separately in tricuspid and type-0 and type-1 bicuspid aortic valve morphology between the snare and non-snare groups. In 766 patients, despite the snare group having significantly larger annulus angulation and maximal ascending aortic diameter, both groups achieved comparable 30-day device success rates, regardless of first-generation or new-generation valve use. After PSM, the snare group had a significantly lower new permanent pacemaker implantation rate among 193 type-0 patients (3.3% vs. 18.3%, p = 0.01). The ipsilateral group used new-generation valves less frequently (23.0% vs. 75.4%, p < 0.001), but there were no significant inter-group differences in procedure-related events, except for a lower incidence of PVL ≥ mild in the ipsilateral group (14.9% vs. 32.3%, p = 0.01). In conclusion, the snare-assisted technique appears useful in SE-TAVR with angulated aortic root anatomy, and the benefits were comparable between ipsilateral and contralateral snare techniques. MDPI 2023-08-01 /pmc/articles/PMC10420027/ /pubmed/37568469 http://dx.doi.org/10.3390/jcm12155067 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Yao, Yi-Jun
Zhao, Zhen-Gang
Wang, Xi
Peng, Yong
Wei, Jia-Fu
He, Sen
Li, Yi-Jian
He, Jing-Jing
Zhu, Zhong-Kai
Feng, Yuan
Chen, Mao
Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies
title Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies
title_full Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies
title_fullStr Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies
title_full_unstemmed Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies
title_short Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies
title_sort snaring self-expanding devices to facilitate transcatheter aortic valve replacement in patients with complex aortic anatomies
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10420027/
https://www.ncbi.nlm.nih.gov/pubmed/37568469
http://dx.doi.org/10.3390/jcm12155067
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