Feasibility and safety of transcaval transcatheter aortic valve implantation: a multicentre European registry

被引:17
作者
Costa, Giulia [1 ]
De Backer, Ole [1 ]
Pilgrim, Thomas [2 ]
Kasel, Markus [3 ]
Redwood, Simon [4 ]
Aminian, Adel [5 ]
Lanz, Jonas [2 ]
Michel, Jonathan [3 ]
Patterson, Tiffany [4 ]
Windecker, Stephan [2 ]
Prendergast, Bernard [4 ]
Greenbaum, Adam B. [6 ]
Sondergaard, Lars [1 ]
机构
[1] Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
[2] Bern Univ Spital, Inselspital, Bern, Switzerland
[3] Deutsch Herzzentrum Munich, Munich, Germany
[4] St Thomas Hosp, London, England
[5] Ctr Hosp Univ Charleroi, Charleroi, Belgium
[6] Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
关键词
aortic stenosis; other; TAVI; ACCESS; REPLACEMENT; CLOSURE;
D O I
10.4244/EIJ-D-19-00797
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims: A transfemoral transarterial approach is considered the preferable access route for transcatheter aortic valve implantation (TAVI), followed by a transaxillary/subclavian TAVI approach. However, these approaches may not be an option in all patients. This study aimed to report the initial European experience with transfemoral transcaval TAVI. Methods and results: Data on 50 patients treated by transcaval TAVI in five European centres were collected and analysed according to the Valve Academic Research Consortium (VARC)-2 definitions. The study population had a mean age of 78.7 +/- 8.0 years and a high surgical risk profile (median STS risk score 6.1%, interquartile range 3.0-11.2%). Transcaval access was successful in 49 out of 50 patients and device success was obtained in 94% of cases. Closure of the caval-aortic puncture site with a nitinol cardiac occluder was successful in all cases without need for emergent surgery. One patient received additional sealing of the aortic puncture site with a covered stent one day post TAVI due to a gradual haemoglobin drop of 3 g/dL. VARC-2-defined life-threatening bleeding and major vascular complications possibly related to transcaval access were 4% and 10%, respectively. There were no bleeding or vascular complications after discharge. At 30 days, the clinical efficacy endpoint was reached in 88% of patients. Conclusions: Transfemoral transcaval access proved to be a feasible and safe TAVI approach for high-risk patients with severe aortic stenosis not suitable for transfemoral or transaxillary/subclavian transarterial access.
引用
收藏
页码:E1319 / U30
页数:8
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