Transcatheter Aortic Valve Replacement Using Transaortic Access

被引：38

作者：

Bapat, Vinayak ^{[1
]}

Frank, Derk ^{[2
]}

Cocchieri, Ricardo ^{[3
]}

Jagielak, Dariusz ^{[4
]}

Bonaros, Nikolaos ^{[5
]}

Aiello, Marco ^{[6
]}

Lapeze, Joel ^{[7
]}

Laine, Mika ^{[8
]}

Chocron, Sidney ^{[9
]}

Muir, Douglas ^{[10
]}

Eichinger, Walter ^{[11
]}

Thielmann, Matthias ^{[12
]}

Labrousse, Louis ^{[13
]}

Rein, Kjell Arne ^{[14
]}

Verhoye, Jean-Philippe ^{[15
]}

Gerosa, Gino ^{[16
]}

Baumbach, Hardy ^{[17
]}

Bramlage, Peter ^{[18
]}

Deutsch, Cornelia ^{[18
]}

Thoenes, Martin ^{[19
]}

Romano, Mauro ^{[20
]}

机构：

[1] St Thomas Hosp, London, England

[2] UKSH, Dept Internal Med Cardiol & Angiol 3, Kiel, Germany

[3] Univ Amsterdam, Acad Med Ctr, Ctr Heart, NL-1012 WX Amsterdam, Netherlands

[4] Med Univ Gdansk, Dept Cardiac & Vasc Surg, Gdansk, Poland

[5] Med Univ Innsbruck, Univ Hosp Cardiac Surg, A-6020 Innsbruck, Austria

[6] Univ Pavia, Sch Med, Fdn IRCCS Policlin S Matteo, Dept Cardiothorac Surg, Pavia, Italy

[7] Hosp Louis Pradel, Dept Cardiovasc Surg, Lyon, France

[8] Univ Helsinki, Cent Hosp, Div Cardiol, Helsinki, Finland

[9] Univ Hosp Besancon, Hosp Jean Minjoz, Cardiothorac Surg, Besancon, France

[10] James Cook Hosp, Cardiothorac Div, Middlesbrough, Cleveland, England

[11] Klinikum Bogenhausen, Dept Cardiothorac Surg, Munich, Germany

[12] Univ Hosp Essen, West German Heart Ctr, Dept Thorac & Cardiovasc Surg, Essen, Germany

[13] CHU Hosp Bordeaux, Dept Cardiovasc Surg, Bordeaux, France

[14] Rikshosp Oslo, Dept Cardiothorac Surg, Oslo, Norway

[15] CHU Rennes, Dept Cardiovasc Surg, Rennes, France

[16] Univ Padua, Dept Cardiac Surg, I-35100 Padua, Italy

[17] Robert Bosch Krankenhaus Stuttgart, Dept Cardiovasc Surg, Stuttgart, Germany

[18] Inst Pharmacol & Prevent Med, Cloppenburg, Germany

[19] Edwards Lifesci, Med Affairs Profess Educ, Nyon, Switzerland

[20] Inst Hosp Jacques Cartier, Massy, France

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2016年 / 9卷 / 17期

关键词：

access; TAVR; transaortic; transapical; transcatheter heart valve; transfemoral; HIGH-RISK PATIENTS; UNITED-STATES; IMPLANTATION; EXPERIENCE; STENOSIS; OUTCOMES; REGISTRY; MULTICENTER; OPTION; ROUTE;

D O I：

10.1016/j.jcin.2016.06.031

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES The Registry of the Utilization of the TAo-TAVR approach using the Edwards SAPIEN Valve (ROUTE) was established to assess the effectiveness and safety of the use of transaortic (TAo) access for transcatheter aortic valve replacement (TAVR) procedures (NCT01991431). BACKGROUND TAVR represents an alternative to surgical valve replacement in high-risk patients. Whereas the transfemoral access route is used commonly as the first-line approach, transapical access is an option for patients not suitable for transfemoral treatment mainly due to anatomic conditions. TAo-TAVR has been shown to be a viable alternative surgical access route; however, only limited data on its effectiveness and safety has been published. METHODS ROUTE is a multicenter, international, prospective, observational registry; data were collected from 18 centers across Europe starting in February 2013. Patients having severe calcific aortic stenosis were documented if they were scheduled to undergo TAo-TAVR using an Edwards SAPIEN XT or a SAPIEN 3 valve. The primary endpoint was 30-day mortality. Secondary endpoints were intraprocedural or in hospital and 30-day complication rates. RESULTS A total of 301 patients with a mean age of 81.7 +/- 5.9 years and an Society of Thoracic Surgeons score of 9.0 +/- 7.6% were included. Valve success was documented in 96.7%. The 30-day mortality was 6.1% (18/293) (procedure-related mortality: 3.1%; 9 of 293). The Valve Academic Research Consortium-2 defined complications included myocardial infarction (1.0%), stroke (1.0%), transient ischemic attack (0.3%), major vascular complications (3.4%), life-threatening bleeding (3.4%), and acute kidney injury (9.5%). In 3.3% of patients, paravalvular regurgitation was classified as moderate or severe (10 of 300). Twenty-six patients (8.8%) required permanent pacemaker implantation. CONCLUSIONS TAo access for TAVR seems to be a safe alternative to the transapical procedure. (C) 2016 by the American College of Cardiology Foundation.

引用

页码：1815 / 1822

页数：8

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