In-Hospital Outcomes with Transfemoral Versus Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Peripheral Arterial Disease

Elbadawi, Ayman; Naqvi, Syed Yaseen; Saad, Marwan; Elgendy, Islam Y.; Mahmoud, Ahmed; Zainal, Abir; Megaly, Michael; Almahmoud, Mohamed Faher; Al-Taweel, Ahmed A; Kleiman, Neal S.; Abbott, J. Dawn

doi:10.1016/j.carrev.2019.09.009

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…These data suggest that the greater invasiveness of the TA procedure does not necessarily affect post-operative outcomes. As expected, we registered a few minor vascular complications and only one minor access-related complication, thereby supporting previous studies that highlighted the higher incidence of major vascular complications in TF-TAVR compared to TA-TAVR [ 8 , 18 , 19 , 20 , 21 , 22 ]. Furthermore, several studies comparing the two access routes reported a higher percentage of permanent PM implantation after TF-TAVR [ 8 , 18 , 19 , 20 , 21 , 22 ].…”

Section: Discussionsupporting

confidence: 90%

“…As expected, we registered a few minor vascular complications and only one minor access-related complication, thereby supporting previous studies that highlighted the higher incidence of major vascular complications in TF-TAVR compared to TA-TAVR [8,[18][19][20][21][22]. Furthermore, several studies comparing the two access routes reported a higher percentage of permanent PM implantation after TF-TAVR [8,[18][19][20][21][22]. Of note, post-operative PM implantation was necessary in only 1.9% of our patients.…”

Section: Discussionsupporting

confidence: 90%

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Transapical Transcatheter Aortic Valve Replacement: A Real-World Early and Mid-Term Outcome of a Third-Level Centre

Francica

Tonelli

SARAN

et al. 2022

JCM

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Background: Transapical transcatheter aortic valve replacement (TA-TAVR) is generally considered to be associated with higher morbidity compared with transfemoral-TAVR. However, TA-TAVR remains a feasible alternative for patients who are unsuitable for TF-TAVR. It has been shown that outcomes after TAVR are linked to the operator’s expertise. Therefore, the purpose of this study is to report short- and mid-term outcomes after TA-TAVR performed by an expert Heart-Team of a third-level centre. Methods: From 2015 to 2022, 154 consecutive patients underwent TA-TAVR. The outcomes were analysed according to the VARC-3 criteria. Kaplan–Meier curves were estimated for major clinical events at mid-term follow-up. Results: The mean age of the population was 79.3 years and the STS risk-score of mortality was 4.2 ± 3.6%. Periprocedural mortality was 1.9%. Acute kidney injury and prolonged ventilation occurred in 1.9%. Incidence of stroke was 0.6%. Pacemaker implantation rate was 1.9%. Freedom from cardiovascular mortality was 75.7%, and 60.2% at 3 and 5 years. Freedom from stroke was 92.3% and 88.9% at 3 and 5 years, respectively; freedom from endocarditis was 94.4% and 90.8% at 3 and 5 years, respectively. Conclusion: TA-TAVR may be considered a safe and effective alternative approach in patients unsuitable for TF-TAVR, especially when performed by a proficient Heart-Team.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Transapical Transcatheter Aortic Valve Replacement: A Real-World Early and Mid-Term Outcome of a Third-Level Centre

Francica

Tonelli

SARAN

et al. 2022

JCM

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“…To handle this, one might use variables/ metrics (e.g., outpatient surgeries on potential outpatient procedures, decubitus ulcerate) to approximate personal healthcare quality. 57 Access evaluation may also involve several metrics (e.g., rate of first medical appointments within time, hospital beds per 1000 inhabitants, purchasing power per capita), as performed by Cournane et al 58 and Elbadawi et al 59 These metrics provide the performance on overall healthcare access and quality by providing a robust…”

Section: Quality Of Care and Accessmentioning

confidence: 99%

“…Access evaluation may also involve several metrics (e.g., rate of first medical appointments within time, hospital beds per 1000 inhabitants, purchasing power per capita), as performed by Cournane et al 58 . and Elbadawi et al 59 . These metrics provide the performance on overall healthcare access and quality by providing a robust indicator of what can or should be taken into account in an effective healthcare plan 57 …”

Section: Vertical Integration In Healthcarementioning

confidence: 99%

Vertical integration in healthcare: What does literature say about improvements on quality, access, efficiency, and costs containment?

Amado

Marques

Nunes

2022

Health Planning & Management

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Introduction: Vertical integration models involve integrating services from different levels of care (e.g., primary care, acute care, post-acute care). Therefore, one of their main objectives is to increase continuity of care, potentially improving outcomes like efficiency, quality, and access or even enabling cost containment.Objectives: This study conducts a literature review and aims at contributing to the contentious discussion regarding the effects of vertical integration reforms in terms of efficiency, costs containment, quality, and access.Methods: We performed a systematic search of the literature published until February 2020. The articles respecting the conceptual framework were included in an exhaustive analysis to study the impact of vertical integration on costs, prices of care, efficiency, quality, and access.Results: A sample of 64 papers resulted from the screening process. The impact of vertical integration on costs and prices of care appears to be negative. Decreases in technical efficiency upon vertical integration are practically out of the question. Nevertheless, there is no substantial inclination to visualise a positive influence. The same happens with the quality of care. Regarding access, the lack of available articles on this outcome limits conjectures.Conclusions: In summary, it is not clear yet whether vertically integrated healthcare providers positively impact the overall delivery care system. Nevertheless, the recent grow-

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“…For example, transcatheter aortic valve replacement typically has much less blood loss than open aortic valve replacement, and studies have shown decreased rates of transfusion with comparable mortality. 40,41 Similarly, robotic and minimally invasive procedures generally have lower blood loss compared to open approaches ( e.g. , urologic and gynecologic surgeries).…”

Section: Preoperative Considerationsmentioning

confidence: 99%

Perioperative Management of Patients for Whom Transfusion Is Not an Option

Guinn

Resar²,

Frank³

2021

Anesthesiology

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In-Hospital Outcomes with Transfemoral Versus Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Peripheral Arterial Disease

Cited by 6 publications

References 23 publications

Transapical Transcatheter Aortic Valve Replacement: A Real-World Early and Mid-Term Outcome of a Third-Level Centre

Transapical Transcatheter Aortic Valve Replacement: A Real-World Early and Mid-Term Outcome of a Third-Level Centre

Vertical integration in healthcare: What does literature say about improvements on quality, access, efficiency, and costs containment?

Perioperative Management of Patients for Whom Transfusion Is Not an Option

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