Transcaval Versus Transaxillary TAVR in Contemporary Practice

Lederman, Robert J.; Babaliaros, Vasilis; Lisko, John; Rogers, Toby; Mahoney, Paul; Foerst, Jason; Depta, Jeremiah P.; Muhammad, Kamran I.; McCabe, James M.; Pop, Andrei; Khan, Jaffar; Bruce, Christopher G.; Medranda, Giorgio A.; Wei, Junhao; Binongo, José; Greenbaum, Adam

doi:10.1016/j.jcin.2022.03.014

Cited by 29 publications

(29 citation statements)

References 30 publications

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“…Transcaval access conferred bleeding and vascular complications similar to transaxillary access but lower femoral-like rates of stroke and discharge directly to home. 14 Selection bias does not appear to account for the different outcomes, before or after inverse-propensity weighting of baseline characteristics. Sites included a mix of operators who preferentially employed one route or the other (3 transaxillary versus 5 transcaval) and 3 that abandoned the transaxillary approach before the study period.…”

Section: Clinical Experience and Outcomesmentioning

confidence: 99%

Transcatheter Electrosurgery: A Narrative Review

Bruce

Khan

Rogers

et al. 2023

Circ: Cardiovascular Interventions

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Transcatheter electrosurgery describes the ability to cut and traverse tissue, at a distance, without an open surgical field and is possible using either purpose-built or off-the-shelf devices. Tissue traversal requires focused delivery of radiofrequency energy to a guidewire tip. Initially employed to cross atretic pulmonary valves, tissue traversal has enabled transcaval aortic access, recanalization of arterial and venous occlusions, transseptal access, and many other techniques. To cut tissue, the selectively denuded inner curvature of a kinked guidewire (the Flying-V) or a single-loop snare is energized during traction. Adjunctive techniques may complement or enable contemporary transcatheter procedures, whereas myocardial slicing or excision of ectopic masses may offer definitive therapy. In this contemporary review we discuss the principles of transcatheter electrosurgery, and through exemplary clinical applications highlight the range of therapeutic options offered by this versatile family of procedures.

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Section: Clinical Experience and Outcomesmentioning

confidence: 99%

Transcatheter Electrosurgery: A Narrative Review

Bruce

Khan

Rogers

et al. 2023

Circ: Cardiovascular Interventions

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“…Multi-sliced CT is crucial for the assessment of the feasibility of this approach as prerequisites involve a sufficiently large calcium-free target zone (≥ 1 cm) of the right abdominal wall and a trajectory free of obstacles (bowel) (69,77). A recent propensity-weighted analysis of transcaval vs. transaxillary TAVI in contemporary practice showed that patients undergoing transcaval TAVI had lower rates of stroke and similar bleeding compared to those with transaxillary access; however, both approaches were associated with more complications, including worse bleeding, vascular complications, stroke or TIA, intensive care unit and hospital length of stay, and 30-day and 1-year mortality (78). The 10.3389/fcvm.2022.971762 transcaval strategy has several advantages including the absolute percutaneous nature of the vessel access, no myocardial or chest wall injury and initial access through the distensible femoral vein allows the accommodation of all sheath sizes.…”

Section: Transcatheter Aortic Valve Implantation In Patients Unsuitab...mentioning

confidence: 99%

A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence

Καλογερόπουλος

Redwood

Allen

et al. 2022

Front. Cardiovasc. Med.

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Since the first groundbreaking procedure in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis (AS). Through striking developments in pertinent equipment and techniques, TAVI has now become the leading therapeutic strategy for aortic valve replacement in patients with severe symptomatic AS. The procedure streamlining from routine use of conscious sedation to a single arterial access approach, the newly adapted implantation techniques, and the introduction of novel technologies such as intravascular lithotripsy and the refinement of valve-bioprosthesis devices along with the accumulating experience have resulted in a dramatic reduction of complications and have improved associated outcomes that are now considered comparable or even superior to surgical aortic valve replacement (SAVR). These advances have opened the road to the use of TAVI in younger and lower-risk patients and up-to-date data from landmark studies have now established the outstanding efficacy and safety of TAVI in patients with low-surgical risk impelling the most recent ESC guidelines to propose TAVI, as the main therapeutic strategy for patients with AS aged 75 years or older. In this article, we aim to summarize the most recent advances and the current clinical aspects involving the use of TAVI, and we also attempt to highlight impending concerns that need to be further addressed.

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“…Data from the STS/ACC TVT registry comprising 1,180 transaxillary and trans-subclavian TAVR procedures revealed a stroke risk of 6.3%, which was significantly higher than transthoracic approaches with an odds ratio of 2.1 ( 35 ). Similarly, transaxillary and trans-subclavian TAVR have been shown to be associated with higher stroke risks when compared to transcarotid and transcaval approaches ( 45 , 46 ) ( Table 2 ).…”

Section: Transaxillary and Trans-subclavian Tavrmentioning

confidence: 99%

“…In a recently published propensity-weighted analysis involving 238 patients who received transcaval TAVR from eight experienced centers in the United States, it was shown that transcaval TAVR was superior to transaxillary access with respect to stroke risk with an odds ratio of 0.2 ( p = 0.014). Furthermore, the trend toward lower mortality and acute renal failure risk was observed, and also statistical significance was not reached ( 46 ).…”

Section: Transcaval Tavrmentioning

confidence: 99%

Advances in technology and techniques for transcatheter aortic valve replacement with concomitant peripheral arterial disease

Wong

Chiu²,

Chan³

et al. 2022

Front. Med. Technol.

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Aortic stenosis (AS) is a prevalent disease affecting 3.7% of the adult population aged 65 or above. In the past, surgical aortic valve replacement (SAVR) was the only definitive therapy available for the treatment of severe AS. Owing to the invasive nature of open-heart surgery, patients with advanced age and frailty could not benefit from SAVR. The advent of transcatheter aortic valve replacement (TAVR) in the past decade has offered an alternative treatment option for patients with severe AS, particularly those who are deemed to have high surgical risks. Nevertheless, a large proportion of patients also have concomitant peripheral arterial disease (PAD), which increases the risk of peri-procedural vascular complication, and precludes the possibility of transfemoral TAVR owing to inadequate luminal size for delivery system deployment. In this review, the prevalence and outcome of TAVR patients with PAD will be discussed. Furthermore, novel technologies and techniques that enable TAVR to be safely performed using transfemoral or alternative access in patients with severe PAD will be reviewed.

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Transcaval Versus Transaxillary TAVR in Contemporary Practice

Cited by 29 publications

References 30 publications

Transcatheter Electrosurgery: A Narrative Review

Transcatheter Electrosurgery: A Narrative Review

A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence

Advances in technology and techniques for transcatheter aortic valve replacement with concomitant peripheral arterial disease

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