Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease
<b>Objective</b>: 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 transaort...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-11-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/9/12/422 |
| _version_ | 1797457106766397440 |
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| author | Enrico Ferrari Alberto Pozzoli Catherine Klersy Francesca Toto Tiziano Torre Tiziano Cassina Giovanni Pedrazzini Stefanos Demertzis |
| author_facet | Enrico Ferrari Alberto Pozzoli Catherine Klersy Francesca Toto Tiziano Torre Tiziano Cassina Giovanni Pedrazzini Stefanos Demertzis |
| author_sort | Enrico Ferrari |
| collection | DOAJ |
| description | <b>Objective</b>: 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. <b>Methods</b>: 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. <b>Results</b>: From March 2012 to March 2022, 81 TA and 82 TAO-TAVR (total: 163 cases) were performed with balloon-expanding (<i>n</i> = 120; 73.6%) and self-expandable (<i>n</i> = 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 (<i>p</i> = 0.032). Females were more represented in the TAO-TAVR group (56% vs. 32%; <i>p</i> = 0.003) while TA-TAVR patients showed a higher prevalence of previous vascular surgery (20% vs. 6%; <i>p</i> = 0.01), previous cardiac surgery (51% vs. 3.6%; <i>p</i> < 0.001), and porcelain aorta (22% vs. 5%; <i>p</i> = 0.001). The mean ejection fraction was 49.0 ± 14.6% (TA) and 53.5 ± 12.2% (TAO) (<i>p</i> = 0.035) while mean gradients were 35.6 ± 13.2 mmHg (TA) and 40.4 ± 16.1 mmHg (TAO) (<i>p</i> = 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 (<i>p</i> = 0.005). The procedural time was shorter for TA procedures (97 min (IQR: 882–118) vs. 102 min (IQR: 88–129); <i>p</i> = 0.133). Mortality at day 30 was 6% in both groups (<i>p</i> = 1.000); the permanent pacemaker implantation rate was similar (8.6% vs. 9.7%; <i>p</i> = 1.000), and hospital stay was shorter for the TAO group (8 days (IQR: 6–11) vs. 10 days (IQR: 7–13); <i>p</i> = 0.025). <b>Conclusions</b>: 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. |
| first_indexed | 2024-03-09T16:16:28Z |
| format | Article |
| id | doaj.art-0dad1846d5364b4191c28d62f35c3360 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-09T16:16:28Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-0dad1846d5364b4191c28d62f35c33602023-11-24T15:41:31ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252022-11-0191242210.3390/jcdd9120422Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular DiseaseEnrico Ferrari0Alberto Pozzoli1Catherine Klersy2Francesca Toto3Tiziano Torre4Tiziano Cassina5Giovanni Pedrazzini6Stefanos Demertzis7Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, SwitzerlandCardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, SwitzerlandClinical Epidemiology & Biostatistics, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyCardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, SwitzerlandCardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, SwitzerlandBiomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, SwitzerlandBiomedical Faculty, University of Italian Switzerland (USI), 6900 Lugano, SwitzerlandCardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland<b>Objective</b>: 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. <b>Methods</b>: 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. <b>Results</b>: From March 2012 to March 2022, 81 TA and 82 TAO-TAVR (total: 163 cases) were performed with balloon-expanding (<i>n</i> = 120; 73.6%) and self-expandable (<i>n</i> = 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 (<i>p</i> = 0.032). Females were more represented in the TAO-TAVR group (56% vs. 32%; <i>p</i> = 0.003) while TA-TAVR patients showed a higher prevalence of previous vascular surgery (20% vs. 6%; <i>p</i> = 0.01), previous cardiac surgery (51% vs. 3.6%; <i>p</i> < 0.001), and porcelain aorta (22% vs. 5%; <i>p</i> = 0.001). The mean ejection fraction was 49.0 ± 14.6% (TA) and 53.5 ± 12.2% (TAO) (<i>p</i> = 0.035) while mean gradients were 35.6 ± 13.2 mmHg (TA) and 40.4 ± 16.1 mmHg (TAO) (<i>p</i> = 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 (<i>p</i> = 0.005). The procedural time was shorter for TA procedures (97 min (IQR: 882–118) vs. 102 min (IQR: 88–129); <i>p</i> = 0.133). Mortality at day 30 was 6% in both groups (<i>p</i> = 1.000); the permanent pacemaker implantation rate was similar (8.6% vs. 9.7%; <i>p</i> = 1.000), and hospital stay was shorter for the TAO group (8 days (IQR: 6–11) vs. 10 days (IQR: 7–13); <i>p</i> = 0.025). <b>Conclusions</b>: 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.https://www.mdpi.com/2308-3425/9/12/422transcatheter aortic valve replacementaortic valve stenosisdirect transaortic accesstransapical access |
| spellingShingle | Enrico Ferrari Alberto Pozzoli Catherine Klersy Francesca Toto Tiziano Torre Tiziano Cassina Giovanni Pedrazzini Stefanos Demertzis Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease Journal of Cardiovascular Development and Disease transcatheter aortic valve replacement aortic valve stenosis direct transaortic access transapical access |
| 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 | transcatheter aortic valve replacement aortic valve stenosis direct transaortic access transapical access |
| url | https://www.mdpi.com/2308-3425/9/12/422 |
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