Right Transaxillary Transcatheter Aortic Valve Replacement Using the “Flip-n-Flex” Technique

Zhan, Yong; Kawabori, Masashi; Lofftus, Serena; Cobey, Frederick C.; Rastegar, Hassan; Weintraub, Andrew; Chen, Frederick Y.

doi:10.1016/j.athoracsur.2019.05.040

Cited by 4 publications

(3 citation statements)

References 24 publications

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“…Low-profile delivery systems facilitate the conduct of the procedure. An improvement in the fluoroscopy time in right TAx-TAVR owing to the ‘flip-n-flex’ technique was described in our previous report [ 10 ]. As a result, the fluoroscopy time of the entire TAx cohort was similar to the TF cohort.…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of transaxillary transcatheter aortic valve replacement using a current-generation balloon-expandable valve

Zhan¹,

Toomey²,

Ortoleva³

et al. 2020

J Cardiothorac Surg

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Background Transaxillary access (TAx) has shown promise as an excellent alternative TAVR option, but data on the Edwards SAPIEN 3 in TAx-TAVR is limited. We sought to study the safety and efficacy of TAx-TAVR using this current-generation balloon-expandable valve. Methods A retrospective study of our first 24 TAx and 20 transthoracic (TT) TAVR patients treated with the SAPIEN 3 valve was performed, and the patients’ preoperative characteristics, procedural outcomes, and clinical outcomes were compared to our first 100 transfemoral (TF) patients using the SAPIEN 3 device. Results There were no statistical differences observed for outcomes between the TAx and TF groups, despite the TAx patients having more comorbidities (STS-PROM 11.3 ± 7.6 versus 7.3 ± 5.2, p = 0.042). In addition, no significant difference was found in the fluoroscopy time and contrast amount between the two groups. The patients’ baseline characteristics were similar between the TAx and TT groups. Their procedural and clinical outcomes were comparable, but there was a trend towards lower incidence of acute kidney injury (13.0% versus 23.5%), new-onset atrial fibrillation (5.6% versus 33.3%), shorter median length of stay postoperatively (4 versus 6 days), fewer discharges to rehabilitation (16.7% versus 35.0%), and a lower rate of readmission within 30-days (8.3% versus 35.0%), all favoring TAx access. Conclusions TAx-TAVR with the SAPIEN 3 valve is a safe alternative to TF access. It offers advantages of improved recovery over TT access, and appears to be a superior alternative-access option for TAVR. TAx access could be preferred when TF access is not feasible.

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Section: Discussionmentioning

confidence: 99%

“…The procedural technique for TAx-TAVR has been reported previously [10]. In brief, it is performed under general anesthesia via a surgical cut-down to expose the axillary artery for direct puncture (Fig.…”

Section: Surgical Techniquementioning

confidence: 99%

Safety and efficacy of transaxillary transcatheter aortic valve replacement using a current-generation balloon-expandable valve

Zhan¹,

Toomey²,

Ortoleva³

et al. 2020

J Cardiothorac Surg

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“…Thus these 31 studies were used in the quantitative meta-analysis ( Fig. 1), with 2,883 and 2,172 patients in the DAo TAVR and TAx TAVR groups, respectively (Adamo et al, 2015;Arai et al, 2016;Bonaros et al, 2017;Bruschi et al, 2017Bruschi et al, , 2015Cocchieri et al, 2019;D'Ancona et al, 2019;Dahle & Rein, 2014;Dahle, Kaneko & McCabe, 2019;Damluji et al, 2018;Fiorina et al, 2017;Gilard et al, 2012;Gleason et al, 2018;Hysi et al, 2019;Jagielak et al, 2015;Khan et al, 2018;Laflamme et al, 2014;Muensterer et al, 2013;Okuyama et al, 2015;Petzina et al, 2017;Ramlawi et al, 2015;Ribeiro et al, 2015;Romano et al, 2019;Ropponen et al, 2016;Schäfer et al, 2017;Spargias et al, 2014;Terzian et al, 2017;Testa et al, 2012;Thourani et al, 2015;Wendt et al, 2015;Zhan et al, 2020).…”

Section: Literature Searchmentioning

confidence: 99%

Direct aortic route versus transaxillary route for transcatheter aortic valve replacement: a systematic review and meta-analysis

Lee

Chen

et al. 2020

PeerJ

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Background The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels. Transaxillary (TAx) and direct aortic (DAo) routes are the principal nonfemoral TAVR routes; however, few studies have compared their outcomes. Methods We performed a systematic review and meta-analysis to compare the rates of mortality, stroke, and other adverse events of TAx and DAo TAVR. The study was prospectively registered with PROSPERO (registration number: CRD42017069788). We searched Medline, PubMed, Embase, and Cochrane databases for studies reporting the outcomes of DAo or TAx TAVR in at least 10 patients. Studies that did not use the Valve Academic Research Consortium definitions were excluded. We included studies that did not directly compare the two approaches and then pooled rates of events from the included studies for comparison. Results In total, 31 studies were included in the quantitative meta-analysis, with 2,883 and 2,172 patients in the DAo and TAx TAVR groups, respectively. Compared with TAx TAVR, DAo TAVR had a lower Society of Thoracic Surgery (STS) score, shorter fluoroscopic time, and less contrast volume use. The 30-day mortality rates were significantly higher in the DAo TAVR group (9.6%, 95% confidence interval (CI) = [8.4–10.9]) than in the TAx TAVR group (5.7%, 95% CI = [4.8–6.8]; P for heterogeneity <0.001). DAo TAVR was associated with a significantly lower risk of stroke in the overall study population (2.6% vs. 5.8%, P for heterogeneity <0.001) and in the subgroup of studies with a mean STS score of ≥8 (1.6% vs. 6.2%, P for heterogeneity = 0.005). DAo TAVR was also associated with lower risks of permanent pacemaker implantation (12.3% vs. 20.1%, P for heterogeneity = 0.009) and valve malposition (2.0% vs. 10.2%, P for heterogeneity = 0.023) than was TAx TAVR. Conclusions DAo TAVR increased 30-day mortality rate compared with TAx TAVR; by contrast, TAx TAVR increased postoperative stroke, permanent pacemaker implantation, and valve malposition risks compared with DAo TAVR.

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An Updated Comprehensive Review of Existing Transcatheter Aortic Valve Replacement Access

Sheng,

Dai,

Zheng

et al. 2024

J. of Cardiovasc. Trans. Res.

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Right Transaxillary Transcatheter Aortic Valve Replacement Using the “Flip-n-Flex” Technique

Cited by 4 publications

References 24 publications

Safety and efficacy of transaxillary transcatheter aortic valve replacement using a current-generation balloon-expandable valve

Safety and efficacy of transaxillary transcatheter aortic valve replacement using a current-generation balloon-expandable valve

Direct aortic route versus transaxillary route for transcatheter aortic valve replacement: a systematic review and meta-analysis

An Updated Comprehensive Review of Existing Transcatheter Aortic Valve Replacement Access

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