The Transaortic Approach for Transcatheter Aortic Valve Replacement

Lardizabal, Joel A.; O’Neill, Brian; Desai, Harit; Macon, Conrad; Rodríguez, Alexis; Martinez, Claudia; Alfonso, Carlos; Bilsker, Martin; Carillo, Roger; Cohen, Mauricio G.; Heldman, Alan W.; O’Neill, William W.; Williams, Donald B.

doi:10.1016/j.jacc.2013.02.076

Cited by 92 publications

(16 citation statements)

References 17 publications

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“…21 This approach is very familiar to cardiac surgeons and the proximity to the aortic valve under direct aortic access probably provides improved catheter control during implantation. Simultaneous OPCAB with transaortic TAVI has been introduced for patients with comorbidities that require avoiding cardiopulmonary bypass.…”

Section: Resultsmentioning

confidence: 99%

Early Results of Simultaneous Transaortic Transcatheter Aortic Valve Implantation and Total Arterial Off-Pump Coronary Artery Revascularization in High-Risk Patients

Kobayashi

Shimahara

Fujita

et al. 2016

Circ J

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Background: Transcatheter aortic valve implantation (TAVI) has become an alternative procedure for treating aortic stenosis (AS) in patients with advanced age and severe comorbidities. Ischemic heart disease (IHD) is present with AS in 40-50% of patients with typical angina. Considering the high operative mortality and morbidity rates in these patients, hybrid TAVI and off-pump CABG (OPCAB) have become realistic treatment options. Methods and Results:Between August 2014 and November 2015, 12 patients were evaluated for simultaneous TAVI and OPCAB. Because of their advanced age and comorbidities these patients were not considered suitable for standard open heart surgery. PCI was also considered unsuitable, because of left anterior descending artery (LAD) proximal lesions and/or high SYNTAX score. TAVI was conducted through a median sternotomy after left internal thoracic artery (LITA) to LAD anastomosis. In 11 cases OPCAB with LITA and composite RA graft was performed using an aorta no-touch technique. Mean age at operation was 81±6.3 years. Average number of distal anastomoses was 2.6. Perivalvular leakage was mild in 3 patients, trivial in 8, and none in 1. There was no conversion to on-pump procedure and no hospital deaths. Conclusions:Simultaneous transaortic TAVI and OPCAB in high-risk patients with severe AS and IHD is a reasonable option. This method could be an alternative to surgical aortic valve replacement and CABG. (Circ J 2016; 80: 1946 -1950

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Section: Resultsmentioning

confidence: 99%

Early Results of Simultaneous Transaortic Transcatheter Aortic Valve Implantation and Total Arterial Off-Pump Coronary Artery Revascularization in High-Risk Patients

Kobayashi

Shimahara

Fujita

et al. 2016

Circ J

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“…In early reports, Clarke et al [11] found good ease of access and visibility using this method, while Lardizabal et al [15] demonstrated superior mortality rates compared to the TA approach, with comparable complication rates. The short distance from the puncture site to the annulus enabled by the TAo access provides excellent and immediate tactile feedback [16].…”

Section: Discussionmentioning

confidence: 97%

Transaortic transcatheter aortic valve implantation: Results of the Polish arm of the ROUTE registry

et al. 2015

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“…In non-randomized studies, the transaortic approach has been shown to result in similar clinical outcomes when compared with the TA approach. 26, 27 Potential advantages of the transaortic approach are avoidance of a thoracotomy and injury to the myocardium and apex, as well as potential for direct visualization of the aorta. In patients with specific high-risk comorbidities such as chronic obstructive pulmonary disease and left ventricular systolic dysfunction, these advantages of the transaortic approach may result in superior HRQoL outcomes.…”

Section: Discussionmentioning

confidence: 99%

Temporal Trends in Quality of Life Outcomes After Transapical Transcatheter Aortic Valve Replacement

Gada

Kirtane

Wang

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background In the PARTNER randomized controlled trial (RCT), which represented the first exposure to transapical transcatheter aortic valve replacement (TA-TAVR) for many clinical sites, high risk patients undergoing TA-TAVR derived similar health-related quality-of-life (HRQoL) outcomes when compared with surgical AVR (SAVR). With increasing experience, it is possible that HRQoL outcomes of TA-TAVR may have improved. Methods and Results We evaluated HRQoL outcomes at 1-, 6-, and 12-month follow-up among 875 patients undergoing TA-TAVR in the PARTNER non-randomized continued access (NRCA) registry, and compared these outcomes with those of the TA-TAVR and SAVR patients in the PARTNER RCT. HRQoL was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Medical Outcomes Study Short Form-12, and the EuroQoL-5D, with the KCCQ overall summary score serving as the primary endpoint. The NRCA TA-TAVR and RCT TA-TAVR and SAVR groups were generally similar. The primary outcome, the KCCQ summary score, did not differ between the NRCA TA-TAVR and the RCT TA-TAVR group at any follow-up timepoints, although there were small differences in favor of the NRCA cohort on several KCCQ subscales at 1 month. There were no significant differences in follow-up HRQOL between the NRCA-TAVR and the RCT SAVR cohorts on the KCCQ overall summary scale or any of the disease-specific or generic subscales. Conclusions Despite greater experience with TA-TAVR in the NRCA registry, HRQoL outcomes remained similar to those of TA-TAVR in the original RCT cohort and no better than those with SAVR. These findings have important implications for patient selection for TAVR when transfemoral access is not an option. Clinical Trial Registration Placement of AoRTic TraNscathetER Valve [PARTNER] trial; NCT00530894; http://clinicaltrials.gov/show/NCT00530894

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The Transaortic Approach for Transcatheter Aortic Valve Replacement

Abstract: TAVR via the TAO approach is technically feasible, seems to be associated with favorable outcomes, and expands the current alternative options for access sites in patients with inoperable aortic stenosis who are ineligible for TF TAVR.

Cited by 92 publications

References 17 publications

Early Results of Simultaneous Transaortic Transcatheter Aortic Valve Implantation and Total Arterial Off-Pump Coronary Artery Revascularization in High-Risk Patients

Early Results of Simultaneous Transaortic Transcatheter Aortic Valve Implantation and Total Arterial Off-Pump Coronary Artery Revascularization in High-Risk Patients

Transaortic transcatheter aortic valve implantation: Results of the Polish arm of the ROUTE registry

Temporal Trends in Quality of Life Outcomes After Transapical Transcatheter Aortic Valve Replacement

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