Comparative Outcomes of Transcarotid and Transsubclavian Transcatheter Aortic Valve Replacement

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 retrospective analysis of all TAVR procedures performed through either a transcarotid or a transsubclavian approach at a single tertiary care medical center between January 2016 and October 2018 was performed. Outcomes are reported in accordance with the Valve Academic Research Consortium definitions.ResultsDuring the study period, 33 patients had transcarotid TAVR and 38 patients had transsubclavian TAVR. Transcarotid patients were older (mean age, 82.9 ± 7.2 vs 78.1 ± 8.2 years; P = .012), but otherwise the two groups were not significantly different with respect to preoperative characteristics. Valve deployment was similar between the groups (100% vs 97%; P = .348). Procedure time was shorter with the transcarotid approach (110 ± 32 vs 134 ± 45 minutes; P = .014). There was a lower mean fluoroscopy air kerma in the trans...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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To assess the impact of stroke volume index (SVI) and left ventricular ejection fraction (LVEF) on prognosis in patients with severe aortic stenosis, comparing those undergoing transcatheter aortic valve replacement (TAVR) and those with surgical AVR (SAVR).
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Original article Source Type: research
Publication date: January 2020Source: Canadian Journal of Cardiology, Volume 36, Issue 1Author(s): Mohammad Alkhalil, Paul Brennan, Conor McQuillan, Reuben Jeganathan, Ganesh Manoharan, Colum G. Owens, Mark S. SpenceAbstractBackgroundTools are needed to identify patients at increased risk after transcatheter aortic valve replacement (TAVR). Indexed stroke volume (SVi) is an echocardiographic measurement that is used for low-gradient aortic stenosis. We studied whether low SVi is a high-risk marker in patients with high-gradient aortic stenosis (HG-AS) and assessed the relationship between SVi and left ventricle (LV) systol...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
CONCLUSIONS: Our meta-analysis indicates that, in the short term, TAVI probably has little or no mortality difference compared to SAVR for severe AS in individuals with low surgical risk. Similarly, there is probably little or no difference in risk of stroke, MI, and cardiac death between the two approaches. TAVI may reduce the risk of rehospitalisation, but we are uncertain about the effects on LOS. TAVI reduces the risk of atrial fibrillation, AKI, and bleeding. However, this benefit is offset by the increased risk of PPM implantation. Long-term follow-up data are needed to further assess and validate these outcomes, esp...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
ConclusionsThis analysis shows that there are 3 distinct phases of cost accumulation from referral to post-TAVR with some potentially modifiable cost drivers in each phase.
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
TRANSCATHETER aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement in high-risk patients with severe aortic stenosis. However, there are increasing concerns about the potential complications of TAVI now that its indications have been expanded to include patients with low-to-intermediate surgical risk.1,2 One of the serious complications of TAVI is stroke. It is known that there is an increase in 30-day mortality, rates of respiratory insufficiency and postprocedural delirium, and duration of hospital stay if stroke occurs.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Case Report 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
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