Transcatheter Aortic Valve Implantation by the Left Axillary Approach: A Single-Center Experience

被引:19
作者
Laflamme, Maxime
Mazine, Amine
Demers, Philippe
Lamarche, Yoan
Ibrahim, Reda
Asgar, Anita
Cartier, Raymond [1 ]
机构
[1] Montreal Heart Inst, Dept Cardiac Surg, Montreal, PQ H1T 1C8, Canada
关键词
PERMANENT PACEMAKER REQUIREMENT; REPLACEMENT; STENOSIS; PROSTHESIS; RETROGRADE; PREDICTORS; DISEASE;
D O I
10.1016/j.athoracsur.2013.11.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Transcatheter aortic valve implantation (TAVI) is an accepted alternative treatment for severe symptomatic aortic stenosis in high-risk and inoperable patients. Femoral or transapical accesses are commonly used. We report our initial clinical experience with TAVI using the left-axillary artery approach. Methods. A single-center, retrospective study of patients undergoing transaxillary TAVI between January 2010 and December 2012 was performed. Procedural success was defined as successful device implantation with reduction in the mean aortic gradient and without need for conversion to open-heart surgery. Short-term echocardiographic follow-up was obtained in all patients. Results. A total of 18 consecutive patients with severe aortic stenosis who were not candidates for surgical replacement underwent transaxillary TAVI. Mean age was 81.1 +/- 7.3 years and 14 patients (78%) were male. Median logistic European System for Cardiac Operative Risk Evaluation was 8.5% (range, 1.5% to 54.1%). Procedural success was obtained in 17 out of 18 patients (94%). There was no in-hospital or 30-day mortality. One major bleeding complication in the form of an upper gastrointestinal bleeding was observed. No stroke or major vascular complication was reported. Postoperative implantation of a permanent pacemaker was performed in 7 patients (39%). At a mean follow-up of 326 +/- 213 days, mean aortic gradient was 10.8 +/- 4.8 mm Hg. Mean aortic valve area was 1.7 +/- 0.4 cm(2) and aortic insufficiency grade was mild or less in all but 1 patient, who showed moderate regurgitation. Conclusions. The transaxillary approach for TAVI is associated with high procedural success and low rates of stroke, vascular, or bleeding complications. This approach is an appealing alternative to the commonly used transfemoral and transapical TAVI. (C) 2014 by The Society of Thoracic Surgeons
引用
收藏
页码:1549 / 1554
页数:6
相关论文
共 23 条
[1]  
[Anonymous], 2009, EUROPCR 2009 BARC
[2]   Postoperative permanent pacemaker implantation in patients undergoing trans-catheter aortic valve implantation: what is the incidence and are there any predicting factors? [J].
Bates, Matthew G. D. ;
Matthews, Iain G. ;
Fazal, Iftikhar A. ;
Turley, Andrew J. .
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, 2011, 12 (02) :243-253
[3]   ACC/AHA 2006 guidelines for the management of patients with valvular heart disease [J].
Bonow, Robert O. ;
Carabello, Blase A. ;
Chatterjee, Kanu ;
de Leon, Antonio C., Jr. ;
Faxon, David P. ;
Freed, Michael D. ;
Gaasch, William H. ;
Lytle, Bruce Whitney ;
Nishimura, Rick A. ;
O'Gara, Patrick T. ;
O'Rourke, Robert A. ;
Otto, Catherine M. ;
Shah, Pravin M. ;
Shanewise, Jack S. ;
Smith, Sidney C., Jr. ;
Jacobs, Alice K. ;
Adams, Cynthia D. ;
Anderson, Jeffrey L. ;
Antman, Elliott M. ;
Faxon, David P. ;
Fuster, Valentin ;
Halperin, Jonathan L. ;
Hiratzka, Loren F. ;
Hunt, Sharon A. ;
Lytle, Bruce W. ;
Nishimura, Rick ;
Page, Richard L. ;
Riegel, Barbara .
CIRCULATION, 2006, 114 (05) :E84-E231
[4]   The Axillary/Subclavian Artery Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review of the Literature [J].
Caceres, Manuel ;
Braud, Rebecca ;
Roselli, Eric E. .
ANNALS OF THORACIC SURGERY, 2012, 93 (03) :1013-1018
[5]  
Charlson E, 2006, J HEART VALVE DIS, V15, P312
[6]   Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis - First human case description [J].
Cribier, A ;
Eltchaninoff, H ;
Bash, A ;
Borenstein, N ;
Tron, C ;
Bauer, F ;
Derumeaux, G ;
Anselme, F ;
Laborde, F ;
Leon, MB .
CIRCULATION, 2002, 106 (24) :3006-3008
[7]   The left axillary artery - a new approach for transcatheter aortic valve implantation [J].
De Robertis, Fabio ;
Asgar, Anita ;
Davies, Simon ;
Delahunty, Nicola ;
Kelleher, Andrea ;
Trimlett, Richard ;
Mullen, Mike ;
Moat, Neil .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2009, 36 (05) :807-812
[8]   Electrocardiographic and further predictors for permanent pacemaker requirement after transcatheter aortic valve implantation [J].
Erkapic, Damir ;
Kim, Won K. ;
Weber, Michael ;
Moellmann, Helge ;
Berkowitsch, Alexander ;
Zaltsberg, Sergey ;
Pajitnev, Dmitri J. ;
Rixe, Johannes ;
Neumann, Thomas ;
Kuniss, Malte ;
Sperzel, Johannes ;
Hamm, Christian W. ;
Pitschner, Heinz F. .
EUROPACE, 2010, 12 (08) :1188-1190
[9]   Percutaneous aortic valve replacement for severe aortic stenosis in high-rick patients using the second- and current third-generation self-expanding CoreValve prosthesis - Device success and 30-day clinical outcome [J].
Grube, Eberhard ;
Schuler, Gerhard ;
Buellesfeld, Lutz ;
Gerckens, Ulrich ;
Linke, Axel ;
Wenaweser, Peter ;
Sauren, Barthel ;
Mohr, Friedrich-Wilhelm ;
Walther, Thomas ;
Zickmann, Bernfried ;
Iversen, Stein ;
Felderhoff, Thomas ;
Cartier, Raymond ;
Bonan, Raoul .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 50 (01) :69-76
[10]   A prospective survey of patients with valvular heart disease in Europe:: The Euro Heart Survey on Valvular Heart Disease [J].
Iung, B ;
Baron, G ;
Butchart, EG ;
Delahaye, F ;
Gohlke-Bärwolf, C ;
Levang, OW ;
Tornos, P ;
Vanoverschelde, JL ;
Vermeer, F ;
Boersma, E ;
Ravaud, P ;
Vahanian, A .
EUROPEAN HEART JOURNAL, 2003, 24 (13) :1231-1243