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Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique

Background: Transcatheter aortic valve implantation (TAVI) is now a well-established therapeutic option in an elderly high-risk patient cohort with aortic valve disease. Although most commonly performed via a transfemoral route, alternative approaches for TAVI are constantly being improved. Instead...

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Autores principales: Pommert, Nina Sophie, Zhang, Xiling, Puehler, Thomas, Seoudy, Hatim, Huenges, Katharina, Schoettler, Jan, Haneya, Assad, Friedrich, Christine, Sathananthan, Janarthanan, Sellers, Stephanie L., Meier, David, Mueller, Oliver J., Saad, Mohammed, Frank, Derk, Lutter, Georg
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455155/
https://www.ncbi.nlm.nih.gov/pubmed/37629253
http://dx.doi.org/10.3390/jcm12165211
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author Pommert, Nina Sophie
Zhang, Xiling
Puehler, Thomas
Seoudy, Hatim
Huenges, Katharina
Schoettler, Jan
Haneya, Assad
Friedrich, Christine
Sathananthan, Janarthanan
Sellers, Stephanie L.
Meier, David
Mueller, Oliver J.
Saad, Mohammed
Frank, Derk
Lutter, Georg
author_facet Pommert, Nina Sophie
Zhang, Xiling
Puehler, Thomas
Seoudy, Hatim
Huenges, Katharina
Schoettler, Jan
Haneya, Assad
Friedrich, Christine
Sathananthan, Janarthanan
Sellers, Stephanie L.
Meier, David
Mueller, Oliver J.
Saad, Mohammed
Frank, Derk
Lutter, Georg
author_sort Pommert, Nina Sophie
collection PubMed
description Background: Transcatheter aortic valve implantation (TAVI) is now a well-established therapeutic option in an elderly high-risk patient cohort with aortic valve disease. Although most commonly performed via a transfemoral route, alternative approaches for TAVI are constantly being improved. Instead of the classical mini-sternotomy, it is possible to achieve a transaortic access via a right anterior mini-thoracotomy in the second intercostal space. We describe our experience with this sternum- and rib-sparing technique in comparison to the classical transaortic approach. Methods: Our retrospective study includes 173 patients who were treated in our institution between January 2017 and April 2020 with transaortic TAVI via either upper mini-sternotomy or intercostal thoracotomy. The primary endpoint was 30-day mortality, and secondary endpoints were defined as major postoperative complications that included admission to the intensive care unit and overall hospital stay, according to the Valve Academic Research Consortium 3. Results: Eighty-two patients were treated with TAo-TAVI by upper mini-sternotomy, while 91 patients received the intercostal approach. Both groups were comparable in age (mean age: 82 years) and in the proportion of female patients. The intercostal group had a higher rate of peripheral artery disease (41% vs. 22%, p = 0.008) and coronary artery disease (71% vs. 40%, p < 0.001) with a history of percutaneous coronary intervention or coronary artery bypass grafting, resulting in significantly higher preinterventional risk evaluation (EuroScore II 8% in the intercostal vs. 4% in the TAo group, p = 0.005). Successful device implantation and a reduction of the transvalvular gradient were achieved in all cases with a significantly lower rate of trace to mild paravalvular leakage in the intercostal group (12% vs. 33%, p < 0.001). The intercostal group required significantly fewer blood transfusions (0 vs. 2 units, p = 0.001) and tended to require less reoperation (7% vs. 15%, p = 0.084). Hospital stays (9 vs. 12 d, p = 0.011) were also shorter in the intercostal group. Short- and long-term survival in the follow-up showed comparable results between the two approaches (30-day, 6-month- and 2-year mortality: 7%, 23% and 36% in the intercostal vs. 9%, 26% and 33% in the TAo group) with acute kidney injury (AKI) and reintubation being independent risk factors for mortality. Conclusions: Transaortic TAVI via an intercostal access offers a safe and effective treatment of aortic valve stenosis.
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spelling pubmed-104551552023-08-26 Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique Pommert, Nina Sophie Zhang, Xiling Puehler, Thomas Seoudy, Hatim Huenges, Katharina Schoettler, Jan Haneya, Assad Friedrich, Christine Sathananthan, Janarthanan Sellers, Stephanie L. Meier, David Mueller, Oliver J. Saad, Mohammed Frank, Derk Lutter, Georg J Clin Med Article Background: Transcatheter aortic valve implantation (TAVI) is now a well-established therapeutic option in an elderly high-risk patient cohort with aortic valve disease. Although most commonly performed via a transfemoral route, alternative approaches for TAVI are constantly being improved. Instead of the classical mini-sternotomy, it is possible to achieve a transaortic access via a right anterior mini-thoracotomy in the second intercostal space. We describe our experience with this sternum- and rib-sparing technique in comparison to the classical transaortic approach. Methods: Our retrospective study includes 173 patients who were treated in our institution between January 2017 and April 2020 with transaortic TAVI via either upper mini-sternotomy or intercostal thoracotomy. The primary endpoint was 30-day mortality, and secondary endpoints were defined as major postoperative complications that included admission to the intensive care unit and overall hospital stay, according to the Valve Academic Research Consortium 3. Results: Eighty-two patients were treated with TAo-TAVI by upper mini-sternotomy, while 91 patients received the intercostal approach. Both groups were comparable in age (mean age: 82 years) and in the proportion of female patients. The intercostal group had a higher rate of peripheral artery disease (41% vs. 22%, p = 0.008) and coronary artery disease (71% vs. 40%, p < 0.001) with a history of percutaneous coronary intervention or coronary artery bypass grafting, resulting in significantly higher preinterventional risk evaluation (EuroScore II 8% in the intercostal vs. 4% in the TAo group, p = 0.005). Successful device implantation and a reduction of the transvalvular gradient were achieved in all cases with a significantly lower rate of trace to mild paravalvular leakage in the intercostal group (12% vs. 33%, p < 0.001). The intercostal group required significantly fewer blood transfusions (0 vs. 2 units, p = 0.001) and tended to require less reoperation (7% vs. 15%, p = 0.084). Hospital stays (9 vs. 12 d, p = 0.011) were also shorter in the intercostal group. Short- and long-term survival in the follow-up showed comparable results between the two approaches (30-day, 6-month- and 2-year mortality: 7%, 23% and 36% in the intercostal vs. 9%, 26% and 33% in the TAo group) with acute kidney injury (AKI) and reintubation being independent risk factors for mortality. Conclusions: Transaortic TAVI via an intercostal access offers a safe and effective treatment of aortic valve stenosis. MDPI 2023-08-10 /pmc/articles/PMC10455155/ /pubmed/37629253 http://dx.doi.org/10.3390/jcm12165211 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
Pommert, Nina Sophie
Zhang, Xiling
Puehler, Thomas
Seoudy, Hatim
Huenges, Katharina
Schoettler, Jan
Haneya, Assad
Friedrich, Christine
Sathananthan, Janarthanan
Sellers, Stephanie L.
Meier, David
Mueller, Oliver J.
Saad, Mohammed
Frank, Derk
Lutter, Georg
Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique
title Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique
title_full Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique
title_fullStr Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique
title_full_unstemmed Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique
title_short Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique
title_sort transcatheter aortic valve implantation by intercostal access: initial experience with a no-touch technique
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455155/
https://www.ncbi.nlm.nih.gov/pubmed/37629253
http://dx.doi.org/10.3390/jcm12165211
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