Puncture Versus Surgical Cutdown Complications of Transfemoral Aortic Valve Implantation (from the Spanish TAVI Registry)

Hernández-Enrı́quez, Marco; Andrea, Rut; Brugaletta, Salvatore; Jiménez‐Quevedo, Pilar; Hernández-García, José M.; Trillo-Nouche, Ramiro; Larman, Mariano; Fernández-Avilés, Francisco; Vázquez-González, Nicolás; Íñiguez, Andrés; Zueco, Javier; Ruíz-Salmerón, Rafael; Valle, Raquel del; Molina, Eduardo; Blanco, Bruno García del; Berenguer, Alberto; Valdés, Mariano; Moreno, Raúl; Urbano-Carrillo, Cristóbal A.; Hernández‐Antolín, Rosana; Gimeno, Federico; Cequier, Ángel; Cruz, Ignacio; López-Mínguez, José Ramón; Aramendi, José I.; Sánchez, Ángel; Goicolea, Javier; Albarrán, Agustín; Díaz, J.F. Jiménez; Navarro, Felipe; Moreu, José; Morist, A. Andres; Fernández-Nofrerías, Eduard; Fernández‐Vázquez, Felipe; Ten, Francisco; Mainar, Vicente; Mari, Belén; Sáenz, Alberto; Alfonso, Fernándo; Diarte, José A.; Sancho, Manuel; Lezáun, R.; Arzamendi, Dabit; Sabaté, Manel

doi:10.1016/j.amjcard.2016.05.054

Cited by 26 publications

(26 citation statements)

References 18 publications

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“…Possible explanations for a higher DPC in BEV could remain on the procedure itself rather than on the valve properties. The use of larger sheaths, predilatation, surgical cut‐down for the femoral access and a higher rate of general anesthesia among the BEV patients could play an important role in this regard . In our study, these factors were not significant in the multivariable analysis, but this might be due to the limited number of patients analyzed.…”

Section: Discussionmentioning

confidence: 67%

Thrombocytopenia after transcatheter aortic valve implantation. A comparison between balloon‐expandable and self‐expanding valves

Hernández-Enrı́quez

Regueiro

Romaguera

et al. 2018

Cathet Cardio Intervent

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Background Thrombocytopenia after transcatheter aortic valve implantation (TAVI) is common and has been related to higher mortality and major complications. No comparison between balloon‐expandable (BEV) and self‐expanding valves (SEV) regarding drop platelet count (DPC) has been reported to date. The objectives of this study were to analyze the differences in DPC between BEVs or SEVs and their prognostic implications in clinical outcomes. Methods We retrospectively analyzed patients undergoing TAVI. Platelet counts after TAVI were collected. Two groups were created: DPC ≤ 30% and DPC > 30%. VARC‐2 criteria were used to define outcomes. Results Study population was composed of 195 patients (age 77.5 ± 6.7, 57.4% males). All of them but one experienced DPC (mean DPC 31.9 ± 15.3%). DPC was significantly higher among the patients treated with BEV compared to those treated with SEV (36.3 ± 15.1% vs 27.7 ± 14.4, P < 0.001). After multivariate analysis, the use of BEV was independently associated with a higher rate of DPC > 30% (67.4% vs 36.0%; OR 3.4; 95% CI, 1.42‐8.16). At 30 days, the DPC > 30% was associated with a higher rate of life‐threatening/major bleeding, major vascular complications, in‐hospital sepsis and mortality. At one year, there were no statistically significant differences in the mortality rate between groups (6.35% vs 10.0%, HR 1.54; 95% CI, 0.56–4.25). Conclusions In this study, the use of BEV was associated with a higher risk of DPC after TAVI. A DPC rate > 30% was associated with an increased risk of major complications at 30 days.

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Section: Discussionmentioning

confidence: 67%

Thrombocytopenia after transcatheter aortic valve implantation. A comparison between balloon‐expandable and self‐expanding valves

Hernández-Enrı́quez

Regueiro

Romaguera

et al. 2018

Cathet Cardio Intervent

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“…Most studies have shown similar major vascular complication rates, 41 whereas some reports have shown higher minor vascular complications rates with the percutaneous approach. 40 Percutaneous approach was associated with more pronounced localized stenosis, dissection, or pseudoaneurysm at the access site. 39 Of note, 4% to 14% 38,42 of patients experienced percutaneous closure device failure contributing to approximately half of vascular complications.…”

Section: Percutaneous Approachmentioning

confidence: 97%

“…37 Percutaneous approach has shown similar in-hospital or 30-day mortality rates compared with surgical cutdown approach in several reports. [36][37][38][39][40][41] Vascular complications were also compared between the two approaches, demonstrating varying incidence rates across studies ranging from 2.4% to 27.1% for major vascular complications when the percutaneous approach is used. 40 The wide variation is due to discrepancy regarding definition of complications, the type and the generation of the transcatheter heart valve, and the study periods.…”

Section: Percutaneous Approachmentioning

confidence: 99%

“…[36][37][38][39][40][41] Vascular complications were also compared between the two approaches, demonstrating varying incidence rates across studies ranging from 2.4% to 27.1% for major vascular complications when the percutaneous approach is used. 40 The wide variation is due to discrepancy regarding definition of complications, the type and the generation of the transcatheter heart valve, and the study periods. Most studies have shown similar major vascular complication rates, 41 whereas some reports have shown higher minor vascular complications rates with the percutaneous approach.…”

Section: Percutaneous Approachmentioning

confidence: 99%

“…42 Regarding bleeding complications, 38,39 a major study demonstrated a significantly lower incidence of major bleeding complications with a percutaneous approach at 30 days (RR: 0.43; 95%CI 0.20-0.93; p=0.03). 40 Additionally, percutaneous approach was associated with a shorter LOS compared with surgical cutdown approach in several studies, 36,37 and a meta-analysis including 9 studies and 4,280 patients. 43 However, LA/CS tends to be more often used in percutaneous approach, which may have affected the LOS.…”

Section: Percutaneous Approachmentioning

confidence: 99%

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Minimalist approach for transcatheter aortic valve replacement

Dallan¹,

Ichibori²,

Attizzani³

2019

J Transcat Intervent

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Transcatheter aortic valve replacement became a routine interventional procedure worldwide, together with improvements in valve technology and optimized implant techniques. The concept of minimalist approach became relevant, aiming at optimal technical implant, fewer perioperative comorbidities, and consequently faster recovery and less associated risks. Compared with surgical aortic valve replacement, reduction of hospital and intensive care unit stay and fewer rates of procedural complications offset the high costs of transcatheter aortic valve replacement valves. The principles of the minimalist approach consist on top performance by experienced structural interventionists, a complete transcatheter basis under local anesthesia and conscious sedation, together with bedside transthoracic echocardiography to access hemodynamic features. It is necessary to customize transcatheter aortic valve replacement optimal procedure by revising how to simplify each aspect of the patient's care process, without losing focus on safety and best outcomes based on individualized patient characteristics, center's expertise, and multidisciplinary care. This review aimed to summarize the current evidence for a minimalist approach to transfemoral transcatheter aortic valve replacement and provide information for its safe and successful implementation and customization.Keywords: Transcatheter aortic valve replacement; Aortic valve/surgery; Aortic valve stenosis; Heart valve prosthesis implantation/methods resumo -O implante transcateter de válvula aórtica tornou-se uma intervenção de rotina em todo o mundo, acompanhando as melhorias na tecnologia das válvulas e a otimização das técnicas de implante. O conceito de abordagem minimalista tornou-se relevante, visando obter um implante tecnicamente ideal, menos comorbidades perioperatórias e, consequentemente, recuperação mais rápida e com menos riscos associados. Em comparação à cirurgia de troca da válvula aórtica, a redução no tempo de hospitalização e na unidade de terapia intensiva, e a menor incidência de complicações do procedimento acabam por compensar os custos mais altos das válvulas para o implante transcateter de válvula aórtica. Os princípios da abordagem minimalista consistem em desempenho superior de intervencionistas estruturais experientes, uma base estrutural completa sob anestesia local e sedação consciente, juntamente da ecocardiografia transtorácica à beira do leito, para avaliar características hemodinâmicas. É necessário customizar um procedimento ideal do implante transcateter de válvula aórtica, procurando simplificar cada um dos aspectos da atenção ao paciente, sem perder o foco na segurança e na obtenção dos melhores desfechos, com base nas características individuais na experiência do centro e no atendimento multidisciplinar. Esta revisão teve como objetivo sintetizar as evidências atuais para uma abordagem minimalista do implante transcateter de válvula aórtica transfemoral, e fornecer informações para garantir a segurança e o sucesso da implementação e customi...

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Ultrasound guided vascular access site management and left ventricular pacing are associated with improved outcomes in contemporary transcatheter aortic valve replacement: Insights from the OxTAVI registry

Kotronias

Scarsini

Maria

et al. 2019

Cathet Cardio Intervent

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Objectives: To identify clinical and procedural practice predictors of avoidable complications during transcatheter aortic valve replacement (TAVR). Background: TAVR is evolving as a viable strategy for treatment of aortic stenosis (AS). Vascular complications, major bleeding, or pericardial tamponade may be influenced by procedural practice. Methods: The Oxford TAVR (OxTAVI) prospective registry was retrospectively analyzed to identify predictors of avoidable procedural complications in a contemporary cohort of transfemoral TAVR between January 2015 and September 2018. The primary endpoint was defined as a hierarchic composite of in-hospital mortality, pericardial effusion/cardiac tamponade, major bleeding, and vascular access complications. Individual components of the primary endpoint have been analyzed separately. Results: Five-hundred-twenty-nine patients underwent transfemoral TAVR using contemporary techniques during the study period and were enrolled in the OxTAVI registry. Female sex and high frailty were associated with a higher risk of death, major bleeding, vascular complication or pericardial tamponade. The use of ultrasound (US) guidance for vascular access management was independently associated with a reduced composite primary endpoint (OR = 0.35,

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Puncture Versus Surgical Cutdown Complications of Transfemoral Aortic Valve Implantation (from the Spanish TAVI Registry)

Cited by 26 publications

References 18 publications

Thrombocytopenia after transcatheter aortic valve implantation. A comparison between balloon‐expandable and self‐expanding valves

Thrombocytopenia after transcatheter aortic valve implantation. A comparison between balloon‐expandable and self‐expanding valves

Minimalist approach for transcatheter aortic valve replacement

Ultrasound guided vascular access site management and left ventricular pacing are associated with improved outcomes in contemporary transcatheter aortic valve replacement: Insights from the OxTAVI registry

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