TA-TAVR in extreme-risk patients carries a moderate risk of hospital mortality. Severe comorbidities and presence of residual paravalvular leakages affect the mid-term survival, whereas surviving patients have an acceptable quality of life without rehospitalizations for cardiac decompensation.
The correlation of computerized tomography (CT) features with survival of 28 patients with primary intracranial lymphoma was analysed retrospectively. Severe perifocal oedema, periventricular tumours and lesions which were non-homogenously enhancing or non-enhancing were found to be associated with a poor prognosis. The prognosis when multiple lesions were present was almost the same as that of a solitary lesion (p = 0.95). Ring enhancing lesions had considerably longer survival. Lesions in the frontal region and those close to the meninges, enhancing homogeneously, had a better prognosis.
OBJECTIVES
Transfemoral approach is the standard access-route for transcatheter aortic valve replacement (TAVR). However, alternative approaches are needed in a number of patients and accesses such as transapical (TA) TAVR or transcervical (TC) are used. We aimed to compare clinical and echocardiographic outcomes after TA-TAVR or TC-TAVR.
METHODS
All patients who underwent TA- and TC-TAVR for severe aortic stenosis in our institution between 2008 and 2020 were retrospectively included. End points included 30-day all-cause mortality, procedural complications (according to the Valve Academic Research Consortium-2 criteria), procedure duration, intensive care unit (ICU) length of stay (LOS) and overall hospital LOS. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as difference in year of intervention.
RESULTS
TAVR was performed in 176 patients, using a TA approach (n = 127) or a TC approach (n = 49). Baseline clinical and echocardiographic characteristics were comparable between the 2 groups, except age and peripheral artery disease. All-cause 30-day mortality rates were not significantly different (8.5% in the TA group vs 2.3% in the TC group, P = 0.124). TC approach was associated with significantly shorter procedure duration {71.0 [interquartile range (IQR) 52.5–101.0] vs 93 [IQR 80.0–120.0] min, P < 0.001}, shorter ICU LOS [0.0 (IQR 0.0–0.0) vs 1.0 (IQR 1.0–3.0) days, P < 0.001] and shorter hospital LOS [7.0 (IQR 5.0–9.5) vs 14.0 (IQR 10.0–22.0) days, P < 0.001].
CONCLUSIONS
The TC approach may be a good first-choice alternative in case of contraindications to transfemoral-TAVR.
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