Subscribe to RSS
Transcatheter Aortic Valve Implantation in Patients Who Cannot Undergo Transfemoral Access
Introduction Though transfemoral (TF) access has emerged as a gold standard access for patients with aortic stenosis who undergo transcatheter aortic valve implantation (TAVI), there has been no study that has characterized patients who cannot undergo TF access in detail. We aim to evaluate the contraindications for TF access, their incidence, classify them, and provide the outcomes of patients who failed to be TF candidates.
Methods From 925 patients who underwent TAVI between February 2014 and May 2020 at our heart center, 130 patients failed to be TF candidates and underwent transapical-transcatheter aortic valve implantation (TA-TAVI). In this study, we included all those patients who failed to be TF candidates and underwent TA-TAVI using the third-generation balloon expandable valve (Edwards SAPIEN 3 valve [S3]) (116 patients; STS score 6.07 ± 4.4; age 79.4 ± 7).
Results The incidence of patients unsuitable for TF access at our heart center was 14%. We classified this TAVI population into absolute contraindication for TF access n = 84 (72.5%) and increased interventional risk for TF access n = 32 (27.5%). After TA-TAVI of this specific population using S3, the in-hospital mortality and stroke were 1.7 and 1.7%, respectively. The vascular injury rate was 1.7%. We registered no paravalvular leakage ≥2. The pacemaker rate was 7.4%. The mean transvalvular pressure gradient was 8.7 mm Hg.
Conclusion The incidence of patients who cannot undergo TF access or who are at high interventional risk is considerably high. TA-TAVI, supported with sufficient interventional experience and appropriate valve system, represents an excellent alternative for patients with distinct vasculopathy.
D.U. contributed to the conception, design, data collection, acquisition, analysis, interpretation of data, drafting, and revising of the work. B.B. contributed to the conception, design, and revising of the work. H.C. contributed to the statistics, analysis, and interpretation of data and revision. M.S., P.P., and P.H. contributed to data collection and revision. J.S. contributed substantially to the design and intellectual revision of the work. All authors approve this final version for publication and agree to be accountable for all aspects of this work.
Received: 23 December 2020
Accepted: 12 February 2021
Article published online:
13 April 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Buzzatti N, Sala A, Alfieri O. Comparing traditional aortic valve surgery and transapical approach to transcatheter aortic valve implant. Eur Heart J Suppl 2020; 22 (suppl E): E7-E12
- 2 Patel JS, Krishnaswamy A, Svensson LG, Tuzcu EM, Mick S, Kapadia SR. Access options for transcatheter aortic valve replacement in patients with unfavorable aortoiliofemoral anatomy. Curr Cardiol Rep 2016; 18 (11) 110
- 3 Vemulapalli S, Carroll JD, Mack MJ. et al. Procedural volume and outcomes for transcatheter aortic-valve replacement. N Engl J Med 2019; 380 (26) 2541-2550
- 4 Kappetein AP, Head SJ, Généreux P. et al; Valve Academic Research Consortium-2. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg 2013; 145 (01) 6-23
- 5 Walther T, Dewey T, Borger MA. et al. Transapical aortic valve implantation: step by step. Ann Thorac Surg 2009; 87 (01) 276-283
- 6 Leon MB, Smith CR, Mack MJ. et al; PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016; 374 (17) 1609-1620
- 7 Auffret V, Lefevre T, Van Belle E. et al; FRANCE TAVI Investigators. Temporal trends in transcatheter aortic valve replacement in France: FRANCE 2 to FRANCE TAVI. J Am Coll Cardiol 2017; 70 (01) 42-55
- 8 Leon MB, Smith CR, Mack M. et al; PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363 (17) 1597-1607
- 9 Patsalis PC, Alotaibi S, Wolf A. et al. Feasibility of transfemoral aortic valve implantation in patients with aortic disease and simultaneous or sequential endovascular aortic repair. J Invasive Cardiol 2019; 31 (10) 289-295
- 10 Folliguet T, Laurent N, Bertram M. et al. Transcarotid transcatheter aortic valve implantation: multicentre experience in France. Eur J Cardiothorac Surg 2018; 53 (01) 157-161
- 11 Dahle TG, Kaneko T, McCabe JM. Outcomes following subclavian and axillary artery access for transcatheter aortic valve replacement: Society of the Thoracic Surgeons/American College of Cardiology TVT Registry Report. JACC Cardiovasc Interv 2019; 12 (07) 662-669
- 12 Beurtheret S, Karam N, Resseguier N. et al. Femoral versus nonfemoral peripheral access for transcatheter aortic valve replacement. J Am Coll Cardiol 2019; 74 (22) 2728-2739
- 13 Kirker E, Korngold E, Hodson RW. et al. Transcarotid versus subclavian/axillary access for transcatheter aortic valve replacement with SAPIEN 3. Ann Thorac Surg 2020; 110 (06) 1892-1897
- 14 Binder RK, Rodés-Cabau J, Wood DA. et al. Transcatheter aortic valve replacement with the SAPIEN 3: a new balloon-expandable transcatheter heart valve. JACC Cardiovasc Interv 2013; 6 (03) 293-300
- 15 Toppen W, Suh W, Aksoy O. et al. Vascular complications in the Sapien 3 Era: continued role of transapical approach to transcatheter aortic valve replacement. Semin Thorac Cardiovasc Surg 2018; 30 (02) 144-149
- 16 Suri RM, Minha S, Alli O. et al. Learning curves for transapical transcatheter aortic valve replacement in the PARTNER-I trial: technical performance, success, and safety. J Thorac Cardiovasc Surg 2016; 152 (03) 773-780.e14
- 17 Long A, Mahoney P. Comparative intermediate-term outcomes of subclavian and transcaval access for transcatheter aortic valve replacement. J Invasive Cardiol 2020; 32 (12) 463-469
- 18 Beve M, Auffret V, Belhaj Soulami R. et al. Comparison of the transarterial and transthoracic approaches in nontransfemoral transcatheter aortic valve implantation. Am J Cardiol 2019; 123 (09) 1501-1509
- 19 Madigan M, Atoui R. Non-transfemoral access sites for transcatheter aortic valve replacement. J Thorac Dis 2018; 10 (07) 4505-4515
- 20 Généreux P, Webb JG, Svensson LG. et al; PARTNER Trial Investigators. Vascular complications after transcatheter aortic valve replacement: insights from the PARTNER (Placement of AoRTic TraNscathetER Valve) trial. J Am Coll Cardiol 2012; 60 (12) 1043-1052
- 21 Zhan Y, Lofftus S, Kawabori M, Soin A, Chen FY. A meta-analysis comparing transaxillary and transaortic transcatheter aortic valve replacement. Gen Thorac Cardiovasc Surg 2021; 69 (01) 19-26
- 22 Useini D, Haldenwang P, Schlömicher M. et al. Mid-term outcomes after transapical and transfemoral transcatheter aortic valve implantation for aortic stenosis and porcelain aorta with a systematic review of transfemoral versus transapical approach. Thorac Cardiovasc Surg 2020; 68 (07) 623-632
- 23 Vasa-Nicotera M, Sinning JM, Chin D. et al. Impact of paravalvular leakage on outcome in patients after transcatheter aortic valve implantation. JACC Cardiovasc Interv 2012; 5 (08) 858-865
- 24 Nazif TM, Dizon JM, Hahn RT. et al; PARTNER Publications Office. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv 2015; 8 (1 Pt A): 60-69
- 25 Mack MJ, Leon MB, Thourani VH. et al; PARTNER 3 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019; 380 (18) 1695-1705
- 26 Ghatak A, Bavishi C, Cardoso RN. et al. Complications and mortality in patients undergoing transcatheter aortic valve replacement with Edwards SAPIEN & SAPIEN XT valves: a meta-analysis of world-wide studies and registries comparing the transapical and transfemoral accesses. J Interv Cardiol 2015; 28 (03) 266-278