Use of a balloon-expandable transfemoral sheath in a TAVI cohort with complex access site - a propensity score matched analysis

Sedaghat, Alexander; Dobbeler, Conrad von; Sontag, Bruno; Sinning, Jan‐Malte; Fimmers, Rolf; Mellert, Fritz; Schiller, Wolfgang; Welz, Armin; Grube, Eberhard; Nickenig, Georg; Hauptmann, Karl Eugen; Werner, Nikos

doi:10.4244/eijy15m01_10

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…In our clinical practice, additional contralateral angiography and puncture into the pigtail (bull's eye technique) is the standard approach to ensure anterior puncture of the artery during the procedure. Furthermore, the use of dedicated transfemoral access sheaths in high-risk cohorts 27 and modern closure devices, 28 as well as alternative approaches such as transapical access or direct aortic TAVI, should be taken into consideration when transfemoral TAVI is limited or deemed risky.…”

Section: Stent Graft Placement For Asarvimentioning

confidence: 99%

Routine Endovascular Treatment With a Stent Graft for Access-Site and Access-Related Vascular Injury in Transfemoral Transcatheter Aortic Valve Implantation

Sedaghat

Neumann

Schahab

et al. 2016

Circ: Cardiovascular Interventions

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Background-Access-site and access-related vascular injury (ASARVI) is still a major limiting factor in transcatheter aortic valve implantation and affects the outcome of patients. Management strategies for ASARVI include manual compression, stent grafts, and vascular surgery. We hypothesized that the standard use of a self-expanding stent graft for the management of ASARVI is feasible and safe. Methods and Results-Of 407 patients treated by transfemoral transcatheter aortic valve implantation, 110 experienced ASARVI (27.0%). Of these, 96 (87.3%) were managed by the implantation of a self-expanding nitinol stent graft. In the majority of patients, minor vascular complications triggered the implantation of a stent graft (86.5%), mainly because of bleeding (90.6%) and dissection (5.2%) of the common femoral artery with high rates of primary treatment success (97.9%

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Section: Stent Graft Placement For Asarvimentioning

confidence: 99%

Routine Endovascular Treatment With a Stent Graft for Access-Site and Access-Related Vascular Injury in Transfemoral Transcatheter Aortic Valve Implantation

Sedaghat

Neumann

Schahab

et al. 2016

Circ: Cardiovascular Interventions

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“…Second, during the post-expanded phase, the sheaths will be deformed and will lack the initial smooth surface and size. Complete recoil to the initial smaller calibre could lead to a situation that the arterial cut is larger than the introducer, with the risk of bleeding around the sheath 111 – 115 .…”

Section: Discussionmentioning

confidence: 99%

Comparisons of different new-generation transcatheter aortic valve implantation devices for patients with severe aortic stenosis: a systematic review and network meta-analysis

Yang

Liu

et al. 2023

International Journal of Surgery

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Background: Whether there are differences among the new-generation transcatheter aortic valve implantation (TAVI) devices for patients with aortic stenosis remains unclear. The aim of the study was to compare the efficiency and safety of different new-generation TAVI devices for patients with aortic stenosis. Materials and methods: A comprehensive search of PubMed, Embase and Web of Science from their inception to 1 February 2022. Randomized clinical trials and observational studies that compared two or more different TAVI devices were enroled. Pairwise meta-analysis and frequentist network meta-analysis were conducted to pool the outcome estimates of interest. Results: A total of 79 studies were finally included. According to the surface under the cumulative ranking, the top two ranked valves for lower rates of events were as follows: direct flow medical (DFM) (4.6%) and Lotus (48.8%) for lower rate of device success; Sapien 3 (16.8%) and DFM (19.7%) for lower mortality; DFM (8.6%) and Sapien 3 (25.5%) for lower rates of stroke; Evolut (27.6%) and DFM (35.8%) for lower rates of major and life-threatening bleeding; Portico (22.6%) and Sapien 3 (41.9%) for lower rates of acute kidney injury; Acurate (8.6%) and DFM (13.2%) for lower rates of permanent pacemaker implantation; Lotus (0.3%) and Sapien 3 (22.7%) for lower rates of paravalvular leak; Evolut (1.4%) and Portico (29.1%) for lower rates of mean aortic valve gradients. Conclusions: The findings of the present study suggested that the device success rates were comparable among these new-generation valves except for DFM. After excluding DFM, Sapien 3 might be the best effective for decreased mortality and stroke; Lotus might be the best effective for decreased paravalvular leak; Evolut might be the best effective for decreased major and life-threatening bleeding and mean aortic valve gradients; Acurate and Portico might be the best effective for decreased permanent pacemaker implantation and acute kidney injury, respectively.

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“…In 2012, the PARTNER trial presented data which showed comparable results of the first generation Edwards Sapien THV (Edwards Lifesciences Co., Irvine, CA, USA) and SAVR for severe aortic stenosis in high-risk patients regarding mortality, reduction in symptoms and valve hemodynamics [ 3 ]. Despite introduction of a wide variety of THVs into the medical sector, with largely favorable results [ 4 , 5 ] and improved delivery systems, imaging or access site techniques [ 6 – 8 ], one major problem of THVs remains paravalvular leakage (PVL). PVL has a significantly higher incidence following TAVI compared to SAVR and leads to increased mortality if grade of PVL is ≥ moderate (2-year mortality of 30 % in mild aortic regurgitation, 40 % in moderate, 3-year mortality of 60 % in severe aortic regurgitation) [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Repeat transcatheter aortic valve implantation using a latest generation balloon-expandable device for treatment of failing transcatheter heart valves

Schaefer¹,

Treede²,

Seiffert³

et al. 2016

J Cardiothorac Surg

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BackgroundParavalvular leakage (PVL) is a known complication of transcatheter aortic valve implantation (TAVI) and is associated with poor outcome. Besides balloon-post-dilatation, valve-in-valve (ViV) procedures can be taken into consideration to control this complication. Herein we present initial experience with use of the latest generation balloon-expandable Edwards Sapien 3® (S3) transcatheter heart valve (THV) for treatment of failing THVs.MethodsBetween 01/2014 and 12/2014 three patients (two male, age: 71–80 y, log EUROScore I: 11.89 – 32.63) with failing THVs were refered to our institution for further treatment. THV approach with secondary implantation of an S3 was chosen after mutual agreement of the local interdisciplinary heart team at an interval of 533–1119 days from the index procedure. The performed procedures consisted of: S3 in Sapien XT, JenaValve and CoreValve.ResultsSuccessful transfemoral implantation with significant reduction of PVL was achieved in all cases. No intraprocedural complications occured regarding placement of the S3 with a postprocedural effective orifice area (EOA) of 1.5–2.5 cm2 and pressure gradients of max/mean 14/6–36/16 mmHg. 30-day mortality was 0 %. At the latest follow-up of 90–530 days, all patients are alive and well with satisfactory THV function. Regarding VARC-2 criteria one major bleeding and one TIA was reported.ConclusionsIn the instance of moderate or severe aortic regurgitation after TAVI, S3 ViV deployment is an excellent option to reduce residual regurgitation to none or mild. For further assertions concerning functional outcomes long-term results have to be awaited.

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Use of a balloon-expandable transfemoral sheath in a TAVI cohort with complex access site - a propensity score matched analysis

Cited by 6 publications

References 19 publications

Routine Endovascular Treatment With a Stent Graft for Access-Site and Access-Related Vascular Injury in Transfemoral Transcatheter Aortic Valve Implantation

Routine Endovascular Treatment With a Stent Graft for Access-Site and Access-Related Vascular Injury in Transfemoral Transcatheter Aortic Valve Implantation

Comparisons of different new-generation transcatheter aortic valve implantation devices for patients with severe aortic stenosis: a systematic review and network meta-analysis

Repeat transcatheter aortic valve implantation using a latest generation balloon-expandable device for treatment of failing transcatheter heart valves

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