Transcarotid Transcatheter Aortic Valve Replacement

Mylotte, Darren; Sudre, Arnaud; Teiger, Emmanuel; Obadia, Jean‐François; Lee, M.; Spence, Mark S.; Khamis, Hazem; Nooryani, Arif Al; Delhaye, Cédric; Amr, Gilles; Koussa, Mohamad; Debry, Nicolas; Piazza, Nicolò; Modine, Thomas

doi:10.1016/j.jcin.2015.11.045

Cited by 130 publications

(45 citation statements)

References 24 publications

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“…35,[46][47][48] Previous reports demonstrated the feasibility and safety of the TC approach, mostly with the Medtronic CoreValve THV. 43,49,50 Our experience with the SAPIEN devices is also reassuring.…”

Section: Transcarotid Approachmentioning

confidence: 88%

“…The minimally-invasive surgery of the TC pathway has been mastered by numerous heart teams and recently it has been reported to have similar outcomes to TF access in terms of mortality and morbidity. 49 Recent studies reported a mortality of 6.3 % at 30 days and 16.7 % at one year. Furthermore, rates of 30-day cerebrovascular events in our registry were similar to existing data with transfemoral TAVI, 51 in particular the rate of 30-day stroke was under 2.5 % with TC TAVI.…”

Section: Transcarotid Approachmentioning

confidence: 99%

“…Furthermore, rates of 30-day cerebrovascular events in our registry were similar to existing data with transfemoral TAVI, 51 in particular the rate of 30-day stroke was under 2.5 % with TC TAVI. 44,49,50 Preference for local anaesthesia with conscious sedation to general anaesthesia is team-dependent. Azmoun et al observed in-hospital death in two of the 19 patients treated with TC TAVI under local anaesthesia in their cohort.…”

Section: Transcarotid Approachmentioning

confidence: 99%

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Alternate Access for TAVI: Stay Clear of the Chest

Overtchouk

Modine

2018

Interventional Cardiology Review

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Transcatheter aortic valve implantation (TAVI) is currently performed through an alternative access in 15 % of patients. The transapical access is progressively being abandoned as a result of its invasiveness and poor outcomes. Existing data does not allow TAVI operators to favour one access over another — between transcarotid, trans-subclavian and transaortic — because all have specific strengths and weaknesses. The percutaneous trans-subclavian access might become the main surgery-free alternative access, although further research is needed regarding its safety. Moreover, the difficult learning curve might compromise its adoption. The transcaval access is at an experimental stage and requires the development of dedicated cavo-aortic crossing techniques and closure devices.

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Section: Transcarotid Approachmentioning

confidence: 88%

Section: Transcarotid Approachmentioning

confidence: 99%

Section: Transcarotid Approachmentioning

confidence: 99%

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Alternate Access for TAVI: Stay Clear of the Chest

Overtchouk

Modine

2018

Interventional Cardiology Review

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“…Despite a paucity of randomized data on alternate extra-thoracic access such as trans-carotid, subclavian or trans-axillary, single center experience suggests these approaches compare favorably to transthoracic, with acceptable rates of bleeding and vascular access complications (17,22,23). None of these had systematic follow-up imaging or independent adjudication.…”

Section: Discussionmentioning

confidence: 99%

Transcaval Access and Closure for Transcatheter Aortic Valve Replacement

Greenbaum

Babaliaros

Chen

et al. 2017

Journal of the American College of Cardiology

187

124

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Background Transcaval access may enable fully percutaneous transcatheter aortic valve replacement (TAVR) without the hazards and discomfort of transthoracic (transapical or transaortic) access. Objectives We performed a prospective, independently-adjudicated, multi-center, single-arm Investigational Device Exemption trial of transcaval access for TAVR in patients ineligible for femoral artery access and high or prohibitive risk of complications from transthoracic access. Methods 100 subjects underwent attempted percutaneous transcaval access to the abdominal aorta by electrifying a caval guidewire and advancing into a prepositioned aortic snare. After exchanging for a rigid guidewire, conventional TAVR was performed through transcaval introducer sheaths. Transcaval access ports were closed with nitinol cardiac occluders. A core lab analyzed pre-discharge and 30-day abdominal CT. The STS predicted risk of mortality was 9.6 ± 6.3%. Results Transcaval access was successful in 99/100 subjects. Device success (access and closure with a nitinol cardiac occluder without death or emergency surgical rescue) was 98/99, except for one closed only with a covered stent. Inpatient survival was 96% and 30-day survival was 92%. VARC2 life-threatening bleeding and modified VARC2 major vascular complications possibly related to transcaval access were 7% and 13%, respectively. Median length of stay was 4 (2–6) days. There were no vascular complications after discharge. Conclusion Transcaval access enabled TAVR in patients who were not good candidates for transthoracic access. Bleeding and vascular complications, using permeable nitinol cardiac occluders to close the access ports, were common but acceptable in this high risk cohort. Transcaval access should be investigated in patients who are eligible for transthoracic access. Purpose-built closure devices are in development that may simplify the procedure and reduce bleeding. Clinical trial NCT02280824 on clinicaltrials.gov

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“…Combined, these data suggest that there is likely to be little benefit of TAVR over SAVR in operable patients who are ineligible for transfemoral access because of small or diseased iliofemoral arteries. However, newer options for percutaneous or surgical minimally invasive alternate access, such as transcaval,51 subclavian,52 transaxillary,53 or carotid,54 have been shown to be safe and appear to avoid the morbidity of transthoracic access, although none have been compared with transthoracic access in a randomized trial. Some can be performed with patients under conscious sedation, allowing rapid ambulation after TAVR and shorter hospital length of stay.…”

Section: Do Clinical Trials Of Tavr In Low‐risk Patients Herald the Ementioning

confidence: 99%