A. Schäfer, O. Bhadra, L. Conradi, D. Westermann, H. Reichenspurner, O. De Backer, L. Søndergaard, W. Qureshi, N. Kakouros, I. Amat-Santos, T. Kaneko, R. Teles, T. Nolasco, M. Abecasis, N. Werner, J. Sacha, C. Trani, A. Mangieri, A. Regueiro, F. Biancari, M. Niemelä, Francesco Giannini, A. Buono, F. Bruno, M. Savontaus, A. Ielasi, P. Ferraro, G. Biondi‐Zoccai, A. Morello, A. Giordano
BACKGROUND Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI. AIMS This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV). METHODS For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers. Acute procedural, early and 1-month clinical outcomes were adjudicated in accordance with standardized VARC-3 definitions. RESULTS From 432 patients, 368 patients (85.3%, SE group) received self-expanding (SE) THV and 64 patients (14.8%, BE group) received balloon-expandable (BE) THV. Imaging revealed lower axillary artery diameters in the SE group (max/min diameter in mm: 8.4/6.6 vs 9.4/6.8 mm; p < 0.001/p = 0.04) but a higher proportion of axillary tortuosity in BE group (62/368, 23.6% vs 26/64, 42.6%; p = 0.004) with steeper aorta-left ventricle (LV) inflow (55° vs 51°; p = 0.002) and left ventricular outflow tract (LVOT)-LV inflow angles (40.0° vs 24.5°; 0.002). TAx-TAVI was more often conducted by right sided axillary artery in the BE group (33/368, 9.0% vs 17/64, 26.6%; p < 0.001). Device success was higher in the SE group (317/368, 86.1% vs 44/64, 68.8%, p = 0.0015). In logistic regression analysis, BE THV were a risk factor for vascular complications and axillary stent implantation. CONCLUSIONS Both, SE and BE THV can be safely used in TAx-TAVI. However, SE THV were more often used and were associated with a higher rate of device success. While SE THV were associated with lower rates of vascular complications, BE THV were more often used in cases with challenging anatomical circumstances.
背景:经腋窝(TAx)经导管主动脉瓣植入术(TAVI)是不符合经股主动脉瓣植入术条件的患者首选的替代途径。目的:本研究使用经腋窝介入(TAXI)登记来比较不同类型经导管心脏瓣膜(THV)的手术成功率。方法计程车登记收集来自18个中心的TAx-TAVI治疗患者的匿名数据。根据标准化的VARC-3定义判定急性、早期和1个月的临床结果。结果432例患者中，自扩式THV 368例(85.3%，SE组)，可扩式THV 64例(14.8%，BE组)。影像学显示SE组腋窝下动脉直径(最大/分钟直径mm: 8.4/6.6 vs 9.4/6.8 mm;p < 0.001/p = 0.04)，但BE组腋窝扭曲比例更高(62/368,23.6% vs 26/64, 42.6%;p = 0.004)，主动脉-左心室(LV)流入更陡(55°vs 51°;p = 0.002)和左室流出道(LVOT)-左室流入角(40.0°vs 24.5°;0.002)。BE组多经右侧腋窝动脉行TAx-TAVI (33/ 368,9.0% vs 17/ 64,26.6%;p < 0.001)。SE组器械成功率更高(317/368,86.1% vs 44/64, 68.8%， p = 0.0015)。在logistic回归分析中，BE - THV是血管并发症和腋窝支架植入术的危险因素。结论SE和BE THV均可安全用于TAx-TAVI。然而，SE THV更常被使用，并且与更高的设备成功率相关。虽然SE THV与较低的血管并发症发生率相关，但BE THV更常用于具有挑战性解剖环境的病例。
{"title":"Procedural success in transaxillary transcatheter aortic valve implantation according to type of transcatheter heart valve: results from the multicenter TAXI registry.","authors":"A. Schäfer, O. Bhadra, L. Conradi, D. Westermann, H. Reichenspurner, O. De Backer, L. Søndergaard, W. Qureshi, N. Kakouros, I. Amat-Santos, T. Kaneko, R. Teles, T. Nolasco, M. Abecasis, N. Werner, J. Sacha, C. Trani, A. Mangieri, A. Regueiro, F. Biancari, M. Niemelä, Francesco Giannini, A. Buono, F. Bruno, M. Savontaus, A. Ielasi, P. Ferraro, G. Biondi‐Zoccai, A. Morello, A. Giordano","doi":"10.1055/s-0043-1761794","DOIUrl":"https://doi.org/10.1055/s-0043-1761794","url":null,"abstract":"BACKGROUND\u0000Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI.\u0000\u0000\u0000AIMS\u0000This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV).\u0000\u0000\u0000METHODS\u0000For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers. Acute procedural, early and 1-month clinical outcomes were adjudicated in accordance with standardized VARC-3 definitions.\u0000\u0000\u0000RESULTS\u0000From 432 patients, 368 patients (85.3%, SE group) received self-expanding (SE) THV and 64 patients (14.8%, BE group) received balloon-expandable (BE) THV. Imaging revealed lower axillary artery diameters in the SE group (max/min diameter in mm: 8.4/6.6 vs 9.4/6.8 mm; p < 0.001/p = 0.04) but a higher proportion of axillary tortuosity in BE group (62/368, 23.6% vs 26/64, 42.6%; p = 0.004) with steeper aorta-left ventricle (LV) inflow (55° vs 51°; p = 0.002) and left ventricular outflow tract (LVOT)-LV inflow angles (40.0° vs 24.5°; 0.002). TAx-TAVI was more often conducted by right sided axillary artery in the BE group (33/368, 9.0% vs 17/64, 26.6%; p < 0.001). Device success was higher in the SE group (317/368, 86.1% vs 44/64, 68.8%, p = 0.0015). In logistic regression analysis, BE THV were a risk factor for vascular complications and axillary stent implantation.\u0000\u0000\u0000CONCLUSIONS\u0000Both, SE and BE THV can be safely used in TAx-TAVI. However, SE THV were more often used and were associated with a higher rate of device success. While SE THV were associated with lower rates of vascular complications, BE THV were more often used in cases with challenging anatomical circumstances.","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":"175 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121152853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.1093/eurheartj/ehab724.0492
Madeleine Perrett, Nisha Gohil, O. Țica, K. Bunting, D. Kotecha
BACKGROUND Intravenous beta-blockers are commonly used to manage patients with acute atrial fibrillation (AF) and atrial flutter (AFl), but the choice of specific agent is often not evidence-based. METHODS A prospectively-registered systematic review and meta-analysis of randomised trials (PROSPERO: CRD42020204772) to compare the safety and efficacy of intravenous beta-blockers against alternative pharmacological agents. RESULTS Twelve trials comparing beta-blockers with diltiazem, digoxin, verapamil, anti-arrhythmic drugs and placebo were included, with variable risk of bias and 1152 participants. With high heterogeneity (I2 = 87%; p < 0.001), there was no difference in the primary outcomes of heart rate reduction (standardised mean difference - 0.65 beats/minute compared to control, 95% CI - 1.63 to 0.32; p = 0.19) or the proportion that achieved target heart rate (risk ratio [RR] 0.85, 95% CI 0.36-1.97; p = 0.70). Conventional selective beta-1 blockers were inferior for target heart rate reduction versus control (RR 0.33, 0.17-0.64; p < 0.001), whereas super-selective beta-1 blockers were superior (RR 1.98, 1.54-2.54; p < 0.001). There was no significant difference between beta-blockers and comparators for secondary outcomes of conversion to sinus rhythm (RR 1.15, 0.90-1.46; p = 0.28), hypotension (RR 1.85, 0.87-3.93; p = 0.11), bradycardia (RR 1.29, 0.25-6.82; p = 0.76) or adverse events leading to drug discontinuation (RR 1.03, 0.49-2.17; p = 0.93). The incidence of hypotension and bradycardia were greater with non-selective beta-blockers (p = 0.031 and p < 0.001). CONCLUSIONS Across all intravenous beta-blockers, there was no difference with other medications for acute heart rate control in atrial fibrillation and flutter. Efficacy and safety may be improved by choosing beta-blockers with higher beta-1 selectivity.
{"title":"Efficacy and safety of intravenous beta-blockers in acute atrial fibrillation and flutter is dependent on beta-1 selectivity: a systematic review and meta-analysis of randomised trials.","authors":"Madeleine Perrett, Nisha Gohil, O. Țica, K. Bunting, D. Kotecha","doi":"10.1093/eurheartj/ehab724.0492","DOIUrl":"https://doi.org/10.1093/eurheartj/ehab724.0492","url":null,"abstract":"BACKGROUND\u0000Intravenous beta-blockers are commonly used to manage patients with acute atrial fibrillation (AF) and atrial flutter (AFl), but the choice of specific agent is often not evidence-based.\u0000\u0000\u0000METHODS\u0000A prospectively-registered systematic review and meta-analysis of randomised trials (PROSPERO: CRD42020204772) to compare the safety and efficacy of intravenous beta-blockers against alternative pharmacological agents.\u0000\u0000\u0000RESULTS\u0000Twelve trials comparing beta-blockers with diltiazem, digoxin, verapamil, anti-arrhythmic drugs and placebo were included, with variable risk of bias and 1152 participants. With high heterogeneity (I2 = 87%; p < 0.001), there was no difference in the primary outcomes of heart rate reduction (standardised mean difference - 0.65 beats/minute compared to control, 95% CI - 1.63 to 0.32; p = 0.19) or the proportion that achieved target heart rate (risk ratio [RR] 0.85, 95% CI 0.36-1.97; p = 0.70). Conventional selective beta-1 blockers were inferior for target heart rate reduction versus control (RR 0.33, 0.17-0.64; p < 0.001), whereas super-selective beta-1 blockers were superior (RR 1.98, 1.54-2.54; p < 0.001). There was no significant difference between beta-blockers and comparators for secondary outcomes of conversion to sinus rhythm (RR 1.15, 0.90-1.46; p = 0.28), hypotension (RR 1.85, 0.87-3.93; p = 0.11), bradycardia (RR 1.29, 0.25-6.82; p = 0.76) or adverse events leading to drug discontinuation (RR 1.03, 0.49-2.17; p = 0.93). The incidence of hypotension and bradycardia were greater with non-selective beta-blockers (p = 0.031 and p < 0.001).\u0000\u0000\u0000CONCLUSIONS\u0000Across all intravenous beta-blockers, there was no difference with other medications for acute heart rate control in atrial fibrillation and flutter. Efficacy and safety may be improved by choosing beta-blockers with higher beta-1 selectivity.","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134571310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.1093/med/9780198784906.003.0766
W. Daniel, H. Baumgartner, C. Gohlke-Bärwolf, P. Hanrath, D. Horstkotte, K. Koch, A. Mügge, H. Schäfers, F. Flachskampf
The diagnosis of severe aortic stenosis requires consideration of AVA together with flow rate, pressure gradients (the most robust measurement), ventricular function, size and wall thickness, degree of valve calcification and blood pressure, as well as functional status. The assessment of the severity of aortic stenosis in patients with low gradient and preserved ejection fraction remains particularly challenging. The strongest indication for intervention remain symptoms of aortic stenosis (spontaneous or on exercise testing). The presence of predictors of rapid symptom development can justify early surgery in asymptomatic patients, particularly when surgical risk is low. Although current data favour TAVI in elderly patients who are at increased risk for surgery, particularly when a transfemoral access is possible, the decision between TAVI and SAVR should be made by the Heart Team after careful, comprehensive evaluation of the patient, weighing individually risk and benefit.
{"title":"[Aortic stenosis].","authors":"W. Daniel, H. Baumgartner, C. Gohlke-Bärwolf, P. Hanrath, D. Horstkotte, K. Koch, A. Mügge, H. Schäfers, F. Flachskampf","doi":"10.1093/med/9780198784906.003.0766","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0766","url":null,"abstract":"The diagnosis of severe aortic stenosis requires consideration of AVA together with flow rate, pressure gradients (the most robust measurement), ventricular function, size and wall thickness, degree of valve calcification and blood pressure, as well as functional status. The assessment of the severity of aortic stenosis in patients with low gradient and preserved ejection fraction remains particularly challenging. The strongest indication for intervention remain symptoms of aortic stenosis (spontaneous or on exercise testing). The presence of predictors of rapid symptom development can justify early surgery in asymptomatic patients, particularly when surgical risk is low. Although current data favour TAVI in elderly patients who are at increased risk for surgery, particularly when a transfemoral access is possible, the decision between TAVI and SAVR should be made by the Heart Team after careful, comprehensive evaluation of the patient, weighing individually risk and benefit.","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130871165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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