REC Interventional Cardiology最新文献

Introduction and objectives: Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with symptomatic severe aortic stenosis often performed via transfemoral access route (TF-TAVI). Therefore, successful closure of large-bore access sites is essential. This study aims to investigate the safety and effectiveness of the MANTA (Teleflex/Essential Medical, United States) vascular closure device (VCD) in patients undergoing TF-TAVI in an unselected and consecutive cohort of patients.

Methods: We conducted a single-center, observational study of 245 consecutive patients undergoing TF-TAVI in whom the arterial large-bore femoral access was closed with a MANTA device from March 2020 through February 2022. The primary efficacy outcome measure was the rate of VCD failure according to the VARC-3 definition.

Results: Successful closure of the large-bore access site occurred in 92.2% of the patients (n = 226). According to the VARC-3 definition, no major vascular or bleeding complications related to the plug-based VCD were reported. Patients with failed VCDs (7.8%) had significantly smaller minimal femoral artery diameters (6.6 ± 1.1 mm vs 7.6 ± 1.4 mm; P = .005) and consequently, significant higher sheath-to-femoral artery diameter ratios (0.78 ± 0.16 vs 0.69 ± 0.15; P = .019). No other inter-group differences were found.

Conclusions: In this single-center, real-world, unselected large cohort of consecutive patients treated with TF-TAVI, a plug-based VCD for large-bore arteriotomy closure turned out effective and safe, and enabled arterial access-site management with a low rate of complications.

Introduction and objectives: Transfemoral access is globally accepted as the preferential access route for transcatheter aortic valve implantation (TAVI). However, in up to 15% of the patients, this access is considered inadequate. Considering the various alternatives available, the fully percutaneous access routes have been chosen preferentially. This analysis aims to compare outcomes and complications of 3 alternative access routes for transfemoral, trans-subclavian and transcaval TAVI.

Methods: Retrospective analysis of patients referred for TAVI using transfemoral, trans-subclavian, and transcaval accesses in a single tertiary center from 2008 through 2021. The primary endpoints were 30-day and 1-year all-cause mortality rates. The secondary endpoints were technical success, residual moderate-to-severe paravalvular leak, major vascular complication, 30-day stroke, 30-day Valve Academic Research Consortium-2 (VARC-2) major bleeding, and 30-day acute kidney injury (AKIN criteria 2 or 3).

Results: A total of 642 TAVIs were performed (601 transfemoral, 24 trans-subclavian, and 10 transcaval). A total of 7 patients treated via transapical access were excluded. As expected, baseline comorbidities like left ventricular dysfunction, coronary artery disease, atrial fibrillation, chronic kidney disease, and previous stroke were more frequent in the non-femoral groups. The 1-year and 30-day all-cause mortality rates were higher in the non-transfemoral population (HR, 2.88 and HR, 3.53, respectively). The rates of 30-day stroke and acute kidney injury (AKIN 2 or 3) were also significantly lower in transfemoral patients, but similar between trans-subclavian and transcaval patients. The rates of 30-day major bleeding showed a statistically significant tendency towards lower rates in the transfemoral group. The rates of technical success, major vascular complications, and residual moderate or severe perivalvular leak were similar among the 3 groups.

Conclusions: After careful selection, transfemoral access is the preferential access route for TAVI procedures. In intermediate surgical risk patients with severe symptomatic aortic stenosis, non-transfemoral TAVI approaches have poorer outcomes. The worse outcomes of percutaneous alternative access routes are partially associated with worse baseline characteristics.