Systematic Transfemoral Transarterial Transcatheter Aortic Valve Replacement in Hostile Vascular Access
Background: Traditionally, hostile peripheral access patients undergo TAVR via alternative access. We describe the "transfemoral-first" (TF-1) approach in patients with hostile peripheral access. Method(s): Clinical and procedural data were obtained for all TAVR cases performed from August 2016 to July 2017. Computed tomography was used to assess iliofemoral arteries. Patients were divided into three femoral access groups: routine, hostile, and prohibitive. We attempted TF access in all patients with routine and hostile access. Hostile access was defined as: (1) arterial segments with diameter <5.0 mm; or (2) <5.5 mm with severe calcification (270-360degree arc of calcification) or severe tortuosity; or (3) severe tortuosity along with severe calcification. Outcomes of the hostile access group patients who underwent TF-1 are described. The primary endpoint was successful completion of the procedure without major complications by the intended route. The secondary endpoints were procedural complications as defined by the VARC-2 criteria. Result(s): Of 377 consecutive patients, 99.5% underwent TF-1 TAVR; two patients (0.4%) had prohibitive access. Twenty-eight (7.4%) patients had hostile access with access side mean minimal lumen diameter of 4.7 mm (range 3.8-5.4 mm). Twenty-six (92.8%) were successfully treated with TF-1 strategy. Twelve (42.8%) of the 26 patients underwent preparatory endovascular treatment prior to TAVR during the same operating room visit. There was 1 (3.5%) major or life-threatening bleeding complication and 2 (7.1%) major vascular complications. There were no deaths or strokes. Conclusion(s): Using the safe and effective endovascular approach, TF-1 TAVR is feasible for all-comers-including those with hostile access-with low complication rate. Larger studies are warranted to validate this approach.
Successful embolic protection during temporary circulatory support device removal in a patient who required holding of anticoagulation for postoperative hemothorax
Outcomes after transcatheter aortic valve replacement in patients with low versus high gradient severe aortic stenosis in the setting of preserved left ventricular ejection fraction
BACKGROUND:Transcatheter aortic valve replacement (TAVR) for low gradient (LG) severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) remains an area of clinical uncertainty. METHODS:Retrospective review identified 422 patients who underwent TAVR between September 4, 2014 and July 1, 2016. Procedural indication other than severe AS (nâ€‰=â€‰22) or LVEF <50% (nâ€‰=â€‰98) were excluded. Outcomes were defined by valve academic research consortium two criteria when applicable and compared between LG (peak velocity <4.0â€‰m/s and mean gradient <40 mmHg; nâ€‰=â€‰73) and high gradient (HG) (nâ€‰=â€‰229) groups. The LG group was further categorized as low stroke volume index (SVI) (nâ€‰=â€‰41) or normal SVI (nâ€‰=â€‰32). Median follow-up was 747 days [interquartile range 220-1013]. RESULTS:â€‰=â€‰0.39). CONCLUSION/CONCLUSIONS:Patients with preserved LVEF undergoing TAVR for severe AS with LG, including LG with low SVI, have no significant difference in adverse outcomes when compared to patients with HG.
Ascending Aortic Stenting for Acute Supra-aortic Stenosis from Graft Collapse
A 78 year-old man with remote type-A dissection presented with acute-onset dyspnea. Twenty-two years prior, treatment for his aortic disease required replacement of ascending and arch aneurysms with a Dacron graft using graft inclusion technique. He presented currently in cardiogenic shock. Echocardiography demonstrated new severe hypokinesis of all apical segments. Left-heart catheterization revealed a 120mmHg intra-graft gradient. CT arteriography was unrevealing, but intra-aortic ultrasound demonstrated critical intra-graft stenosis. A Palmaz stent was deployed in the stenotic region with gradient resolution. He later underwent aortic root replacement and ascending aneurysm repair (Bio-Bentall technique) and is doing well at 24 months.
OUTCOMES AFTER TRANSCATHETER MITRAL VALVE REPAIR IN PATIENTS WITH CHRONIC KIDNEY DISEASE: AN ANALYSIS OF 5,241 PATIENTS IN THE UNITED STATES [Meeting Abstract]
Enterococcus Faecalis Infective Endocarditis Following Percutaneous Edge-to-Edge Mitral Valve Repair
Adequate P2Y12 Inhibition and Thrombocytopenia after Transcatheter Aortic Valve Replacement [Meeting Abstract]
Contrast-induced nephropathy (CIN) in patients with renal impairment: Pooled data from three prospective, randomized studies comparing iodixanol 320 mg and iopamidol 370mg [Meeting Abstract]
Aorto-Right Ventricular Fistula Post-Transcatheter Aortic Valve Replacement: Multimodality Imaging of Successful Percutaneous Closure
SHORT- AND MID-TERM OUTCOMES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH RENAL INSUFFICIENCY NOT ON HEMODIALYSIS [Meeting Abstract]