TAVI : une revue de la littérature des voies alternatives à l’accès trans-fémoral

Lu, Henri; Müller, Olivier; Eeckhout, Éric; Monney, Pierre; Roguelov, Christan; Marcucci, Carlo; Meziani, Abderrahim; Kirsch, Matthias

doi:10.1016/j.lpmfor.2020.04.016

Cited by 5 publications

(4 citation statements)

References 44 publications

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“…Previous meta-analyses have also found a decreased risk of vascular complications associated with TC-TAVR ( 39 ). An explanation may be that, in TC-TAVR, the CCA is approached, cannulated, and reconstructed surgically, while most TF cases are performed percutaneously, which does not allow direct vascular control ( 1 , 40 ).…”

Section: Discussionmentioning

confidence: 99%

“…The transfemoral (TF) access is considered as the standard route for transcatheter aortic valve replacement (TAVR), due to its minimally invasive nature and to relatively low complication rates. However, it is not suitable in 10–15% of patients, mainly because of anatomical considerations: iliofemoral atherosclerosis, small or heavily calcified vessels, extreme vessel tortuosity or abdominal aortic aneurysms ( 1 ). Alternative accesses such as the transapical (TAp) ( 2 ), transaortic (TAo) ( 3 ), transcarotid (TC), and transsubclavian (TSc) ones ( 4 , 5 ), have been developed for these settings.…”

Section: Introductionmentioning

confidence: 99%

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Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Monney

Hullin

et al. 2021

Front. Cardiovasc. Med.

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Background: The transfemoral (TF) route is the gold-standard access for transcatheter aortic valve replacement (TAVR). In 10–15% of patients, alternative accesses are needed, such as the transcarotid (TC) access. We performed a meta-analysis to compare 30-day mortality and complications between TC-TAVR and TF-TAVR.Methods: We searched PubMed/MEDLINE and EMBASE from inception to January 2021 to identify articles comparing TC-TAVR and TF-TAVR. Patients' baseline characteristics, procedural outcomes, and clinical 30-day outcomes were extracted.Results: We identified 9 studies, among which 2 used propensity-score matching, including 1,374 TC patients and 3,706 TF patients. TC-TAVR was associated with significantly higher EuroSCORE II and Logistic EuroSCORE values (respectively 8.0 ± 6.7 vs. 6.3 ± 5.4, p = 0.002 and 20.8 ± 14.2% vs. 20.0 ± 13.4%, p = 0.04), a higher prevalence of peripheral artery disease (52.6 vs. 32.8%, p = 0.001), previous cardiac surgery (26.3 vs. 22.4%, p = 0.008) and coronary artery disease (64.6 vs. 60.5%, p = 0.020). The pooled results found TC-TAVR to be associated with a significantly higher 30-day mortality risk (RR, 1.41, 95% CI, 1.02–1.96, p = 0.040), and a lower rate of 30-day major vascular complications (RR, 0.48, 95% CI, 0.25–0.92, p = 0.030). No significant difference was found regarding permanent pacemaker implantation, major bleeding and acute kidney injury. A subgroup analysis of the two propensity-score matched studies found a statistically increased risk of 30-day neurovascular complications (RR, 1.61, 95% CI, 1.02–2.55, p = 0.040).Conclusion: Compared with TF-TAVR, TC-TAVR was associated with an increased risk of 30-day mortality, likely related to a higher surgical risk and comorbidity burden, and with an increased risk of 30-day neurovascular complications. Careful preprocedural patient selection and close periprocedural neurological monitoring are paramount.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Monney

Hullin

et al. 2021

Front. Cardiovasc. Med.

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“…During the past twenty years, transcatheter aortic valve implantation (TAVI) has emerged into the rst-line procedure for the treatment of symptomatic severe aortic stenosis in patients aged ≥ 75 or those younger and at high surgical risk [1]. Hence, the volume of TAVI interventions has dramatically increased, and this trend is expected to continue in the coming years [2,3]. Periprocedural ischemic stroke and transient ischemic attack (TIA) are dreaded complications, with an incidence of 2-4%, and are associated with reduced survival and quality of life [4,5].…”

Section: Introductionmentioning

confidence: 99%

Neurovascular Outcomes in Relation With Carotid Artery Stenosis in Patients Undergoing Transcatheter Aortic Valve Implantation

Oestreicher,

Vella,

Muller

et al. 2023

J Invasive Cardiol

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“…Although transfemoral access is considered the default access strategy, 10-15% [4,5] of TAVR candidates are not suitable due to iliofemoral atherosclerosis, small or heavily calcified vessels, mural thrombus, extreme tortuosity or abdominal aortic aneurysms [6]. In these settings, alternative pathways have been developed and include the transapical (TA) [7], transaortic (TAo) [8], brachiocephalic (BC) [9], transcarotid (TCa) [10] and transsubclavian (TSc) [11] approaches.…”

Section: Introductionmentioning

confidence: 99%

Transcervical approach versus transfemoral approach for transcatheter aortic valve replacement

Monney

Fournier

et al. 2021

International Journal of Cardiology

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The transfemoral (TF) approach is the gold-standard access route for transcatheter aortic valve replacement (TAVR). Alternative approaches, among which the transcervical (TC) approach, are needed in some patients. We aimed to compare TC-TAVR with TF-TAVR. Methods: All patients who underwent TAVR in our institution between 2016 and 2020, using Edwards SAPIEN family balloon-expandable transcatheter heart valves, were retrospectively included. Endpoints included 30day all-cause mortality, procedural complications (according to the VARC-2 criteria), procedure duration, hospital length of stay (LOS) and echocardiographic outcomes. 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 anesthesia modality. Results: TAVR was performed in 306 patients, using a TF approach (n = 255) or a TC approach (n = 51). TC-TAVR was associated with significantly higher STS scores (4.06 [IQR (interquartile range), 2.05, 5.56] vs. 2.97 [IQR, 2.08, 4.88], p < 0.001) and higher prevalence of peripheral artery disease, history of stroke, previous cardiovascular surgery. 30-day mortality (hazard ratio, 0.87 [0.77, 9.77], p = 0.909) and stroke rates (2.0% vs. 1.6%, p = 0.840) were similar, as well as procedural duration (74.0 [53.0, 99.5] vs. 77.0 [58.0, 98.0] minutes, p = 0.370), LOS (6.0 [IQR, 3.0, 8.0] vs. 6.0 [IQR, 4.0, 9.0] days, p = 0.175) and postprocedural mean transvalvular gradient (10.00 [IQR, 8.00, 13.00] vs. 10.00 [IQR, 8.00, 12.00] mmHg, p = 0.724). Conclusion: Despite a higher cardiovascular disease burden in TC patients, TC-TAVR and TF-TAVR yielded similar outcomes. TC-TAVR may be a safe alternative when TF-TAVR is contraindicated.

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TAVI : une revue de la littérature des voies alternatives à l’accès trans-fémoral

Cited by 5 publications

References 44 publications

Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Neurovascular Outcomes in Relation With Carotid Artery Stenosis in Patients Undergoing Transcatheter Aortic Valve Implantation

Transcervical approach versus transfemoral approach for transcatheter aortic valve replacement

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