Cargando…

Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease

Objective: Transcatheter aortic valve replacement (TAVR) through alternative access routes is indicated in patients with severe aortic valve stenosis and diseased peripheral arteries. We analysed and compared the outcome of patients undergoing transapical (TA) and direct transaortic (TAO) TAVR proce...

Descripción completa

Detalles Bibliográficos
Autores principales: Ferrari, Enrico, Pozzoli, Alberto, Klersy, Catherine, Toto, Francesca, Torre, Tiziano, Cassina, Tiziano, Pedrazzini, Giovanni, Demertzis, Stefanos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9783693/
https://www.ncbi.nlm.nih.gov/pubmed/36547419
http://dx.doi.org/10.3390/jcdd9120422
_version_ 1784857638291374080
author Ferrari, Enrico
Pozzoli, Alberto
Klersy, Catherine
Toto, Francesca
Torre, Tiziano
Cassina, Tiziano
Pedrazzini, Giovanni
Demertzis, Stefanos
author_facet Ferrari, Enrico
Pozzoli, Alberto
Klersy, Catherine
Toto, Francesca
Torre, Tiziano
Cassina, Tiziano
Pedrazzini, Giovanni
Demertzis, Stefanos
author_sort Ferrari, Enrico
collection PubMed
description Objective: Transcatheter aortic valve replacement (TAVR) through alternative access routes is indicated in patients with severe aortic valve stenosis and diseased peripheral arteries. We analysed and compared the outcome of patients undergoing transapical (TA) and direct transaortic (TAO) TAVR procedures. Methods: Preoperative characteristics, procedural details, and thirty-day outcome of patients undergoing transapical (TA-TAVR group) and direct transaortic (TAO-TAVR group) TAVR procedures were prospectively collected and retrospectively analysed. Results: From March 2012 to March 2022, 81 TA and 82 TAO-TAVR (total: 163 cases) were performed with balloon-expanding (n = 120; 73.6%) and self-expandable (n = 43; 26.4%) valves. The mean age was 79.7 ± 6.2 and 81.9 ± 6.7 years for the TA- and TAO-TAVR groups, respectively (p = 0.032). Females were more represented in the TAO-TAVR group (56% vs. 32%; p = 0.003) while TA-TAVR patients showed a higher prevalence of previous vascular surgery (20% vs. 6%; p = 0.01), previous cardiac surgery (51% vs. 3.6%; p < 0.001), and porcelain aorta (22% vs. 5%; p = 0.001). The mean ejection fraction was 49.0 ± 14.6% (TA) and 53.5 ± 12.2% (TAO) (p = 0.035) while mean gradients were 35.6 ± 13.2 mmHg (TA) and 40.4 ± 16.1 mmHg (TAO) (p = 0.045). The median EuroSCORE-II was 5.0% (IQR: 3.0–11.0) and 3.9% (IQR: 2.5–5.4) for the TA- and TAO-TAVR groups, respectively (p = 0.005). The procedural time was shorter for TA procedures (97 min (IQR: 882–118) vs. 102 min (IQR: 88–129); p = 0.133). Mortality at day 30 was 6% in both groups (p = 1.000); the permanent pacemaker implantation rate was similar (8.6% vs. 9.7%; p = 1.000), and hospital stay was shorter for the TAO group (8 days (IQR: 6–11) vs. 10 days (IQR: 7–13); p = 0.025). Conclusions: Our results show that transapical and direct transaortic TAVR in high-risk patients with diseased peripheral arteries provide satisfactory clinical results with similar thirty-day outcomes.
format Online
Article
Text
id pubmed-9783693
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-97836932022-12-24 Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease Ferrari, Enrico Pozzoli, Alberto Klersy, Catherine Toto, Francesca Torre, Tiziano Cassina, Tiziano Pedrazzini, Giovanni Demertzis, Stefanos J Cardiovasc Dev Dis Article Objective: Transcatheter aortic valve replacement (TAVR) through alternative access routes is indicated in patients with severe aortic valve stenosis and diseased peripheral arteries. We analysed and compared the outcome of patients undergoing transapical (TA) and direct transaortic (TAO) TAVR procedures. Methods: Preoperative characteristics, procedural details, and thirty-day outcome of patients undergoing transapical (TA-TAVR group) and direct transaortic (TAO-TAVR group) TAVR procedures were prospectively collected and retrospectively analysed. Results: From March 2012 to March 2022, 81 TA and 82 TAO-TAVR (total: 163 cases) were performed with balloon-expanding (n = 120; 73.6%) and self-expandable (n = 43; 26.4%) valves. The mean age was 79.7 ± 6.2 and 81.9 ± 6.7 years for the TA- and TAO-TAVR groups, respectively (p = 0.032). Females were more represented in the TAO-TAVR group (56% vs. 32%; p = 0.003) while TA-TAVR patients showed a higher prevalence of previous vascular surgery (20% vs. 6%; p = 0.01), previous cardiac surgery (51% vs. 3.6%; p < 0.001), and porcelain aorta (22% vs. 5%; p = 0.001). The mean ejection fraction was 49.0 ± 14.6% (TA) and 53.5 ± 12.2% (TAO) (p = 0.035) while mean gradients were 35.6 ± 13.2 mmHg (TA) and 40.4 ± 16.1 mmHg (TAO) (p = 0.045). The median EuroSCORE-II was 5.0% (IQR: 3.0–11.0) and 3.9% (IQR: 2.5–5.4) for the TA- and TAO-TAVR groups, respectively (p = 0.005). The procedural time was shorter for TA procedures (97 min (IQR: 882–118) vs. 102 min (IQR: 88–129); p = 0.133). Mortality at day 30 was 6% in both groups (p = 1.000); the permanent pacemaker implantation rate was similar (8.6% vs. 9.7%; p = 1.000), and hospital stay was shorter for the TAO group (8 days (IQR: 6–11) vs. 10 days (IQR: 7–13); p = 0.025). Conclusions: Our results show that transapical and direct transaortic TAVR in high-risk patients with diseased peripheral arteries provide satisfactory clinical results with similar thirty-day outcomes. MDPI 2022-11-28 /pmc/articles/PMC9783693/ /pubmed/36547419 http://dx.doi.org/10.3390/jcdd9120422 Text en © 2022 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
Ferrari, Enrico
Pozzoli, Alberto
Klersy, Catherine
Toto, Francesca
Torre, Tiziano
Cassina, Tiziano
Pedrazzini, Giovanni
Demertzis, Stefanos
Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease
title Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease
title_full Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease
title_fullStr Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease
title_full_unstemmed Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease
title_short Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease
title_sort ten-year experience with transapical and direct transaortic transcatheter aortic valve replacement to address patients with aortic stenosis and peripheral vascular disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9783693/
https://www.ncbi.nlm.nih.gov/pubmed/36547419
http://dx.doi.org/10.3390/jcdd9120422
work_keys_str_mv AT ferrarienrico tenyearexperiencewithtransapicalanddirecttransaortictranscatheteraorticvalvereplacementtoaddresspatientswithaorticstenosisandperipheralvasculardisease
AT pozzolialberto tenyearexperiencewithtransapicalanddirecttransaortictranscatheteraorticvalvereplacementtoaddresspatientswithaorticstenosisandperipheralvasculardisease
AT klersycatherine tenyearexperiencewithtransapicalanddirecttransaortictranscatheteraorticvalvereplacementtoaddresspatientswithaorticstenosisandperipheralvasculardisease
AT totofrancesca tenyearexperiencewithtransapicalanddirecttransaortictranscatheteraorticvalvereplacementtoaddresspatientswithaorticstenosisandperipheralvasculardisease
AT torretiziano tenyearexperiencewithtransapicalanddirecttransaortictranscatheteraorticvalvereplacementtoaddresspatientswithaorticstenosisandperipheralvasculardisease
AT cassinatiziano tenyearexperiencewithtransapicalanddirecttransaortictranscatheteraorticvalvereplacementtoaddresspatientswithaorticstenosisandperipheralvasculardisease
AT pedrazzinigiovanni tenyearexperiencewithtransapicalanddirecttransaortictranscatheteraorticvalvereplacementtoaddresspatientswithaorticstenosisandperipheralvasculardisease
AT demertzisstefanos tenyearexperiencewithtransapicalanddirecttransaortictranscatheteraorticvalvereplacementtoaddresspatientswithaorticstenosisandperipheralvasculardisease