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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MDPI AG
2023-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/15/5067 |
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| author | Yi-Jun Yao Zhen-Gang Zhao Xi Wang Yong Peng Jia-Fu Wei Sen He Yi-Jian Li Jing-Jing He Zhong-Kai Zhu Yuan Feng Mao Chen |
| author_facet | Yi-Jun Yao Zhen-Gang Zhao Xi Wang Yong Peng Jia-Fu Wei Sen He Yi-Jian Li Jing-Jing He Zhong-Kai Zhu Yuan Feng Mao Chen |
| author_sort | Yi-Jun Yao |
| collection | DOAJ |
| 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%, <i>p</i> = 0.01). The ipsilateral group used new-generation valves less frequently (23.0% vs. 75.4%, <i>p</i> < 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%, <i>p</i> = 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. |
| first_indexed | 2024-03-11T00:23:04Z |
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| language | English |
| last_indexed | 2024-03-11T00:23:04Z |
| publishDate | 2023-08-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-0ea2de1d61e94f6a9a2c11108e76aee02023-11-18T23:08:57ZengMDPI AGJournal of Clinical Medicine2077-03832023-08-011215506710.3390/jcm12155067Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic AnatomiesYi-Jun Yao0Zhen-Gang Zhao1Xi Wang2Yong Peng3Jia-Fu Wei4Sen He5Yi-Jian Li6Jing-Jing He7Zhong-Kai Zhu8Yuan Feng9Mao Chen10Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaThe 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%, <i>p</i> = 0.01). The ipsilateral group used new-generation valves less frequently (23.0% vs. 75.4%, <i>p</i> < 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%, <i>p</i> = 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.https://www.mdpi.com/2077-0383/12/15/5067transcatheter aortic valve replacementaortic stenosissnareannulus angulationbicuspid aortic valve |
| spellingShingle | Yi-Jun Yao Zhen-Gang Zhao Xi Wang Yong Peng Jia-Fu Wei Sen He Yi-Jian Li Jing-Jing He Zhong-Kai Zhu Yuan Feng Mao Chen Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies Journal of Clinical Medicine transcatheter aortic valve replacement aortic stenosis snare annulus angulation bicuspid aortic valve |
| 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 | transcatheter aortic valve replacement aortic stenosis snare annulus angulation bicuspid aortic valve |
| url | https://www.mdpi.com/2077-0383/12/15/5067 |
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