Comparative Outcomes of Transcarotid and Trans-subclavian Transcatheter Aortic Valve Replacement

Publication date: Available online 4 July 2019Source: The Annals of Thoracic SurgeryAuthor(s): Mostafa R. Amer, Wassim Mosleh, Saurabh Joshi, Jeffery F. Mather, Wael El-Mallah, Mohiuddin Cheema, Raymond G. McKayAbstractBackgroundPrevious reports described successful use of transcarotid and trans-subclavian approaches for the performance of transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis who cannot be treated with transfemoral access. The purpose of the present study was to compare these two alternative approaches with respect to safety, efficacy and procedural efficiency.MethodsRetrospective analysis of all TAVR procedures performed via either a transcarotid or a trans-subclavian approach at a single tertiary care medical center between January 2016 to October 2018 was performed. Outcomes are reported in accordance with the Valve Academic Research Consortium definitions.Results33 and 38 patients had transcarotid TAVR and trans-subclavian TAVR, respectively, during the study period. Transcarotid patients were older (mean age, 82.9±7.2 vs. 78.1±8.2; p=0.012), but otherwise the 2 groups were not significantly different with respect to preoperative characteristics. Valve deployment was similar between the groups (100% vs. 97%; p=0.348). Procedure time was shorter with the transcarotid approach (minutes, 110±32 vs. 134±45; p=0.014). There was a lower mean fluoroscopy air kerma in the transcarotid group (mGy, 682.82&...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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Publication date: January 2020Source: The Annals of Thoracic Surgery, Volume 109, Issue 1Author(s): Mostafa R. Amer, Wassim Mosleh, Saurabh Joshi, Jeffery F. Mather, Wael El-Mallah, Mohiuddin Cheema, Raymond G. McKayBackgroundPrevious reports described successful use of transcarotid and transsubclavian approaches for the performance of transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis who cannot be treated with transfemoral access. The purpose of the present study was to compare these two alternative approaches with respect to safety, efficacy, and procedural efficiency.MethodsA retrospe...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
AbstractAortic stenosis (AS) represents a major healthcare issue because of its ever-increasing prevalence, poor prognosis, and complex pathophysiology. Echocardiography plays a central role in providing a comprehensive morphological and hemodynamic evaluation of AS. The diagnosis of severe AS is currently based on three hemodynamic parameters including maximal jet velocity, mean pressure gradient (mPG) across the aortic valve, and aortic valve area (AVA). However, inconsistent grading of AS severity is common when the AVA is  
Source: Journal of Medical Ultrasonics - Category: Radiology Source Type: research
Differences in Flow-Gradient Patterns Between Severe Bicuspid Aortic Stenosis and Severe Tricuspid Aortic Stenosis - Mechanistic Insight From Multimodal Imaging. Circ J. 2019 Nov 30;: Authors: Kim D, Shim CY, Kim YJ, Nam K, Hong GR, Lee SH, Lee S, Ha JW Abstract BACKGROUND: We investigated the flow-gradient pattern characteristics and associated factors in severe bicuspid aortic stenosis (AS) compared with severe tricuspid AS.Methods and Results:A total of 252 patients with severe AS (115 bicuspid vs. 137 tricuspid) who underwent aortic valve (AV) replacement were retrospectively analyzed. Patie...
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
This article reviews the current data on TAVR in low-risk patients with severe, symptomatic aortic stenosis, highlights the results of the recently published Medtronic Low Risk Randomized Study and PARTNER 3 trials, and describes specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice in this population.Recent FindingsIn low-risk patients, the Medtronic Low Risk Randomized Study demonstrated TAVR to be non-inferior to surgery with respect to the composite endpoint of death or disabling stroke while PARTNER 3 trial proved TAVR to be superior to surgery with regard to the composite e...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
Transcatheter aortic-valve replacement (TAVR) has emerged as a promising strategy for treating patients with severe aortic stenosis. We aimed to compare TAVR with surgical aortic-valve replacement (SAVR) and determine the performance of TAVR over time and within several subgroups. We included 8 randomized trials comparing TAVR vs. SAVR. Compared with SAVR, TAVR was associated with a lower rate of all-cause mortality or disabling stroke at 30-day (odds ratio [OR], 0.72; P=0.004), 1-year (OR, 0.83; P=0.01) and 2-year (OR, 0.86; P=0.02), but not at long-term follow-up (rate ratio [RR], 1.02 [CI, 0.92 to 1.13]; P=0.67).
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
AbstractBackground and Aim of the StudyWe compared early and late outcomes of surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) and pulmonary hypertension (PHT).MethodsWe searched MEDLINE and EMBASE databases until July 2018 for studies comparing patients with AS and none, mild ‐moderate, or severe PHT undergoing SAVR. Random‐effects meta‐analysis was performed.ResultsThere were 12 observational studies with 70  676 patients with median follow‐up 4.0 years (interquartile range, 2.6‐4 years). Compared to patients with no PHT, patients with any PHT undergoing SAVR were older (mea...
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: REVIEW ARTICLE Source Type: research
AbstractBackgroundUntreated symptomatic high-grade aortic stenosis remains a lethal disease requiring individually adapted valve replacement. High-risk surgical patients benefit from transcatheter aortic valve replacement (TAVR), but there is no uniform standard for patient selection and valve sizing and it is still unclear whether transthoracic (TTE) or transesophageal (TEE) echocardiography is superior in preprocedural aortic annulus sizing. As preprocedural sizing of the native aortic annulus diameter is crucial to outcome and survival, we report the results of a direct comparison between preprocedural sizing with TTE a...
Source: Journal of Echocardiography - Category: Cardiology Source Type: research
CONCLUSION: Mortality in CS patients due to decompensated severe AS is high, regardless of interventional treatment strategy. Both eBAV and eTAVR seem feasible. As eTAVR is associated with better initial improvements in hemodynamics and simultaneously avoids sequential interventions, it might be favorable to eBAV in select patients. If eTAVR is not available, eBAV might serve as a "bridge" to elective TAVR. PMID: 31611428 [PubMed - as supplied by publisher]
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
This study aimed to assess the effect of AVR on mitral stenosis hemodynamics and the clinical outcomes of patients with severe aortic stenosis with and without mitral stenosis. METHODS: We retrospectively investigated patients who underwent surgical AVR or transcatheter AVR for severe aortic stenosis from 2008 to 2015. Mean transmitral gradient by Doppler echocardiography ≥4 mm Hg was identified as mitral stenosis; patients were then stratified according to mitral valve area (MVA, by continuity equation) as>2.0 cm2 or ≤2.0 cm2. MVA before and after AVR in patients with mitral stenosis were evaluated. Clinical...
Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
CONCLUSIONS: in patients who are at low surgical risk, TAVI seems to be associated with equivalent mortality up to a median follow up of 2 years compared to SAVR. More data is required before TAVI can be routinely considered as an alternative for SAVR in low risk patients. PMID: 31566571 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
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