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Article ; Online: Transcatheter Aortic Valve Replacement for Severe Aortic Regurgitation in Patients With a Left Ventricular Assist Device.

Dhillon, Ashwat S / Jones, Brandon M / Hodson, Robert W / Korngold, Ethan C

2022 Volume 34, Issue 5, Page(s) E369–E373

Abstract: Background: There are limited invasive treatment options for patients with end-stage heart failure and left ventricular assist device (LVAD) who develop severe aortic valve regurgitation (AR). One option for such patients is transcatheter aortic valve ... ...

Abstract	Background: There are limited invasive treatment options for patients with end-stage heart failure and left ventricular assist device (LVAD) who develop severe aortic valve regurgitation (AR). One option for such patients is transcatheter aortic valve replacement (TAVR). There are limited data on outcomes of patients with LVAD who receive TAVR for severe AR. We present a series of 4 consecutive patients with LVAD who underwent TAVR for severe AR. Methods and results: This is a retrospective chart review of 4 consecutive patients with LVAD who underwent TAVR for severe AR. All 4 patients underwent TAVR with a 34-mm self-expanding valve (Medtronic). One patient received a 29-mm balloon-expandable valve (Edwards Lifesciences) within the self-expanding valve (SEV) to postdilate the SEV and minimize paravalvular leak (PVL). All 4 procedures were technically successful. The patient who received rescue valve-in-valve TAVR continued to have persistent mild to moderate PVL. Conclusion: Although technically challenging, TAVR is a feasible option for carefully selected LVAD patients with severe AR. Procedural issues to consider include oversizing the transcatheter heart valve (THV) while being cognizant of the risks of annular rupture and valve dislocation, anticipating and avoiding ventricular migration of the THV and being ready to postdilate the THV if necessary, to limit hemodynamically significant PVL.
MeSH term(s)	Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Insufficiency/diagnosis ; Aortic Valve Insufficiency/etiology ; Aortic Valve Insufficiency/surgery ; Aortic Valve Stenosis/complications ; Aortic Valve Stenosis/diagnosis ; Aortic Valve Stenosis/surgery ; Cardiac Catheterization/methods ; Heart Valve Prosthesis ; Heart-Assist Devices ; Humans ; Prosthesis Design ; Retrospective Studies ; Transcatheter Aortic Valve Replacement/adverse effects ; Treatment Outcome
Language	English
Publishing date	2022-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1154372-3
ISSN	1557-2501 ; 1042-3931
ISSN (online)	1557-2501
ISSN	1042-3931
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Zs.A 3701: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Comparable Outcomes for Transcarotid and Transfemoral Transcatheter Aortic Valve Replacement at a High Volume US Center.

Jones, Brandon M / Kumar, Vishesh / Chiu, Shih Ting / Korngold, Ethan / Hodson, Robert W / Spinelli, Kateri J / Kirker, Eric B

Seminars in thoracic and cardiovascular surgery

2021 Volume 34, Issue 2, Page(s) 467–474

Abstract: With continued growth of transcatheter aortic valve replacement (TAVR), safe alternative access remains important for patients without adequate transfemoral (TF) access. Registry-based outcomes with transcarotid (TC) TAVR are favorable compared to ... ...

Abstract	With continued growth of transcatheter aortic valve replacement (TAVR), safe alternative access remains important for patients without adequate transfemoral (TF) access. Registry-based outcomes with transcarotid (TC) TAVR are favorable compared to transapical or transaxillary/subclavian, but TC vs TF comparisons have not been made. Our objective was to compare outcomes between TF and TC access routes for TAVR at a high-volume United States center. Methods: We retrospectively evaluated all TF and TC TAVR procedures from June 11, 2014 (first TC case) through December 31, 2019. The primary outcomes were 30-day stroke and 30-day mortality. Secondary outcomes were 1-year stroke, 1-year survival, and 30-day and 1-year life-threatening/major bleeding, vascular complications, and myocardial infarction. Propensity score weighted (PSW) models were used to compare risk-adjusted TF and TC outcomes. Of 1,465 TAVR procedures, 1319 (90%) were TF and 146 (10%) were TC. Procedure time and length of stay did not differ between groups. Unadjusted 30-day stroke (TF = 2.0%, TC = 2.7%, P = 0.536) and mortality (TF = 2.1%, TC = 2.7%, P = 0.629) were similar between groups. PSW 30-day stroke (odds ratio (OR) (95% confidence interval (CI)) = 0.8 (0.2-2.8)) and mortality (OR (95% CI) = 0.8 (0.2-3.0)) were similar between groups. Unadjusted and PSW 30-day major/life threatening bleeding, major vascular complications, and myocardial infarction did not differ between groups. Survival at one year was 90% (88%-92%) for TF patients and 87% (81%-93%) for TC patients (unadjusted P = 0.28, PSW hazard ratio = 1.0 (0.6-1.7)). Transcarotid TAVR is associated with similar outcomes compared to transfemoral TAVR at an experienced, high-volume center.
MeSH term(s)	Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Stenosis/complications ; Aortic Valve Stenosis/diagnostic imaging ; Aortic Valve Stenosis/surgery ; Femoral Artery/diagnostic imaging ; Femoral Artery/surgery ; Hemorrhage/surgery ; Humans ; Myocardial Infarction/complications ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke/etiology ; Transcatheter Aortic Valve Replacement ; Treatment Outcome ; United States
Language	English
Publishing date	2021-03-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1038278-1
ISSN	1532-9488 ; 1043-0679
ISSN (online)	1532-9488
ISSN	1043-0679
DOI	10.1053/j.semtcvs.2021.03.009
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Zs.A 2747: Show issues

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Article ; Online: The Carotid Artery as a Preferred Alternative Access Route for Transcatheter Aortic Valve Replacement.

Kirker, Eric B / Hodson, Robert W / Spinelli, Kateri J / Korngold, Ethan C

The Annals of thoracic surgery

2017 Volume 104, Issue 2, Page(s) 621–629

Abstract: Background: In high-risk patients with severe aortic stenosis, transfemoral (TF) access for transcatheter aortic valve replacement (TAVR) is the preferred access route but is not always feasible. Compared with other alternative access routes, ... ...

Abstract	Background: In high-risk patients with severe aortic stenosis, transfemoral (TF) access for transcatheter aortic valve replacement (TAVR) is the preferred access route but is not always feasible. Compared with other alternative access routes, transcarotid (TC) access is often overlooked by many valvular heart teams. Methods: We report our single-center experience of all patients undergoing TC (n = 25), transapical (TA) (n = 12), or TF (n = 100; limited to most recent cases) TAVR over a 1.5 year period. In-hospital and 30-day outcomes were retrospectively compared between groups using the Kruskal-Wallis and Wilcoxon rank sum tests. Results: TAVR was successfully performed through the left or right carotid artery in all 25 patients. Procedurally, TC and TF procedures were faster than TA procedures (p < 0.001), and patients who underwent TC and TF procedures had shorter intensive care unit (ICU) hours (p = 0.05), ventilator hours (p < 0.001), and length of stay (LOS) (p = 0.01) compared to patients who underwent a TA procedure. No patients who underwent a TC procedure had in-hospital stroke, transient ischemic attack (TIA), or myocardial infarction (MI). One patient who underwent a TC procedure had a TIA by 30-day follow-up, which was not significantly different from the TF (2 patients) or TA groups (0 patients; p = 0.75). In-hospital mortality rates were the same between TC (1 patient) and TF (1 patient) procedures but were significantly greater for TA procedures (2 patients; p = 0.009). Thirty-day mortality rates were low and did not differ between the groups. Conclusions: In our US community hospital setting, TC-TAVR is a safe alternative to TF-TAVR in appropriate patients and has evolved to be our alternative access route of choice if TF access is not feasible.
MeSH term(s)	Aged ; Aged, 80 and over ; Aortic Valve/surgery ; Aortic Valve Stenosis/mortality ; Aortic Valve Stenosis/surgery ; Cardiac Catheterization/methods ; Carotid Artery, Common ; Female ; Femoral Artery ; Follow-Up Studies ; Heart Valve Prosthesis ; Hospital Mortality/trends ; Humans ; Incidence ; Male ; Oregon/epidemiology ; Postoperative Complications/epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Survival Rate/trends ; Time Factors ; Transcatheter Aortic Valve Replacement/methods ; Treatment Outcome
Language	English
Publishing date	2017-08
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2016.12.030
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Article ; Online: Comparison of 26-mm Evolut and 23-mm Sapien 3 Valves in TAVR for Small Aortic Annulus.

Jin, Ruyun / Cox, Emily J / Reynolds, Branden R / Curtis, Brydan D / Hodson, Robert W / Reed, Michael C / Gafoor, Sameer A / Grunkemeier, Gary L / Forrester, Matthew D / Ring, Michael E

The Journal of invasive cardiology

2022 Volume 34, Issue 6, Page(s) E433–E441

Abstract: Background: Patients with small aortic annuli (SAA) are prone to higher post-transcatheter aortic valve replacement (TAVR) transvalvular gradients and development of prosthesis-patient mismatch (PPM). In many patients with SAA, the choice of TAVR valve ... ...

Abstract	Background: Patients with small aortic annuli (SAA) are prone to higher post-transcatheter aortic valve replacement (TAVR) transvalvular gradients and development of prosthesis-patient mismatch (PPM). In many patients with SAA, the choice of TAVR valve commonly involves choosing between the 26-mm Medtronic Evolut 2 (ME26) or the 23-mm Edwards Sapien 3 valve (ES23). We compared echocardiographic and clinical outcomes in patients with SAA undergoing TAVR with either valve. Methods: We queried the Providence St. Joseph Health Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry database for patients undergoing TAVR with either the ES23 or ME26 between July 2015 and December 2018 at 11 hospitals. Post-TAVR echocardiographic and clinical results in-hospital, at 1 month, and at 1 year were examined. High gradient (HG) was defined as mean gradient (MG) ≥20 mm Hg. Results: We identified 1162 patients with SAA undergoing TAVR with either the ME26 (n = 233) or ES23 valve (n = 929). Baseline characteristics between groups were similar. At 1 month, the ME26 was associated with a lower MG than the ES23 (7.7 ± 4.7 mm Hg vs 13.1 ± 4.9 mm Hg; P<.001) and moderate or severe PPM (11% and 3% vs 27% and 13%; P<.001). Occurrence of HG at 1 year was lower with the ME26 valve vs the ES23 valve (0% vs 15%; P<.001). In-hospital and follow-up clinical outcomes to 1 year were similar for both groups. Conclusion: TAVR in SAA with the ME26 is associated with lower incidence of HG or PPM compared with the ES23. While clinical outcomes at 1 year were similar, the long-term implications of these findings remain unknown.
MeSH term(s)	Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Stenosis/diagnosis ; Aortic Valve Stenosis/etiology ; Aortic Valve Stenosis/surgery ; Heart Valve Prosthesis/adverse effects ; Humans ; Prosthesis Design ; Risk Factors ; Transcatheter Aortic Valve Replacement/adverse effects ; Treatment Outcome
Language	English
Publishing date	2022-05-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	1154372-3
ISSN	1557-2501 ; 1042-3931
ISSN (online)	1557-2501
ISSN	1042-3931
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Zs.A 3701: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 272: Show issues
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Article ; Online: Clinical Factors and Outcomes When Real-World Heart Teams Overruled STS Risk Scores in TAVR Cases.

King, Jackson M / Black, Morgan T / Jin, Ruyun / Grunkemeier, Gary L / Reynolds, Branden R / Curtis, Brydan D / Hodson, Robert W / Strehl, Erika A / Gafoor, Sameer A / Forrester, Matthew D / Cox, Emily J / Ring, Michael E

Journal of interventional cardiology

2022 Volume 2022, Page(s) 9926423

Abstract: Objectives: This study was conducted to determine why heart teams recommended transcatheter aortic valve replacement (TAVR) versus surgical AVR (SAVR) for patients at low predicted risk of mortality (PROM) and describe outcomes of these cases.: ... ...

Abstract	Objectives: This study was conducted to determine why heart teams recommended transcatheter aortic valve replacement (TAVR) versus surgical AVR (SAVR) for patients at low predicted risk of mortality (PROM) and describe outcomes of these cases. Background: Historically, referral to TAVR was based predominately on the Society of Thoracic Surgeons (STS) risk model's PROM >3%. In selected cases, heart teams had latitude to overrule these scores. The clinical reasons and outcomes for these cases are unclear. Methods: Retrospective data were gathered for all TAVR and SAVR cases conducted by 9 hospitals between 2013 and 2017. Results: Cases included TAVR patients with STS PROM >3% ( Conclusions: Heart teams recommended TAVR in patients with STS PROM ≤3% primarily due to frailty, hostile chest, severe lung disease, and/or morbid obesity. Similar postoperative outcomes between these patients and those with STS PROM >3% suggest that decisions to overrule STS PROM ≤3% were merited and may have reduced SAVR 30-day mortality rate.
MeSH term(s)	Aortic Valve/surgery ; Aortic Valve Stenosis/surgery ; Frailty/etiology ; Frailty/surgery ; Heart Valve Prosthesis Implantation/adverse effects ; Humans ; Lung Diseases/etiology ; Lung Diseases/surgery ; Obesity, Morbid ; Retrospective Studies ; Risk Factors ; Transcatheter Aortic Valve Replacement/adverse effects ; Treatment Outcome
Language	English
Publishing date	2022-06-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1036325-7
ISSN	1540-8183 ; 0896-4327
ISSN (online)	1540-8183
ISSN	0896-4327
DOI	10.1155/2022/9926423
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Article ; Online: Trends in vascular complications and associated treatment strategies following transfemoral transcatheter aortic valve replacement.

Ullery, Brant W / Jin, Ruyun / Kirker, Eric B / Hayes, Greg / Siwek, Leland / Brevig, James / Hodson, Robert W / Spinelli, Kateri J

Journal of vascular surgery

2020 Volume 72, Issue 4, Page(s) 1313–1324.e5

Abstract: Objective: Vascular complications (VC) and bleeding complications impact morbidity and mortality after transfemoral transcatheter aortic valve replacement (TF-TAVR). Few contemporary studies have detailed these complications, associated treatment ... ...

Abstract	Objective: Vascular complications (VC) and bleeding complications impact morbidity and mortality after transfemoral transcatheter aortic valve replacement (TF-TAVR). Few contemporary studies have detailed these complications, associated treatment strategies, or clinical outcomes. We examined the incidence, predictors, treatment strategies, and outcomes of VCs in a multicenter cohort of patients undergoing TF-TAVR. Methods: We performed a retrospective registry and chart review of all nonclinical trial TF-TAVR patients from seven centers within a five-state hospital system from 2012 to 2016. Bleeding and VC were recorded as defined by the Valve Academic Research Consortium recommendations. Procedural and 30-day outcomes and 1-year mortality were compared between patients with no, minor, or major VC. Multivariable logistic and Cox regressions were used to identify predictors of major VC and mortality, respectively. Results: Over the study period, 1573 patients underwent TF-TAVR, with 96 (6.1%) experiencing a major VC and 77 (4.9%) experiencing a minor VC. The majority of VCs were access site related (74.2%), occurred intraoperatively (52.6%), and required interventional treatment (73.2%). The site, timing, and treatment method of VCs did not significantly change over the study period. Patients with VCs had a greater need for blood transfusion, longer postoperative length of stay, higher rates of cardiac events, increased vascular-related 30-day readmission, and higher 30-day mortality. Female sex (odds ratio [OR], 3.00; 95% CI, 1.91-4.72) and prior percutaneous coronary intervention (OR, 2.14 95% CI, 1.38-3.31) were the strongest predictors of major VC. VCs modestly decreased over the study period: every 90-day increase in surgery date decreased the odds of major VC by 6% (95% CI, 1%-10%). Patients with major VCs had worse 1-year survival (OR, 79%; 95% CI, 69%-86%) compared with patients with minor VCs (OR, 92%; 95% CI, 82%-96%) or no VCs (OR, 88%; 95% CI, 87%-90%; P = .002). However, for patients who survived more than 30 days, the 1-year survival did not differ between groups For patients who survived more than 30 days, male sex (hazard ratio, 1.84; 95% CI, 1.30-2.60) and the logit of STS mortality risk score (hazard ratio, 1.98; 95% CI, 1.48-2.65) were the strongest predictors of mortality. After adjusting for other factors, minor and major VC were not predictors of 1-year mortality for patients who survived more than 30 days. Conclusions: In our contemporary cohort, VCs after TF-TAVR have modestly decreased in recent years, but continue to impact perioperative outcomes. Patient selection, consideration of alternative access routes, and prompt recognition and treatment of VCs are critical elements in optimizing early clinical outcomes after TF-TAVR.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Aortic Valve/surgery ; Aortic Valve Stenosis/mortality ; Aortic Valve Stenosis/surgery ; Female ; Femoral Artery/surgery ; Hospital Mortality ; Humans ; Incidence ; Intraoperative Complications/epidemiology ; Intraoperative Complications/etiology ; Intraoperative Complications/therapy ; Kaplan-Meier Estimate ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Postoperative Hemorrhage/epidemiology ; Postoperative Hemorrhage/etiology ; Postoperative Hemorrhage/therapy ; Registries/statistics & numerical data ; Retrospective Studies ; Risk Assessment/statistics & numerical data ; Risk Factors ; Transcatheter Aortic Valve Replacement/adverse effects ; Treatment Outcome ; Vascular Diseases/epidemiology ; Vascular Diseases/etiology ; Vascular Diseases/therapy ; Young Adult
Language	English
Publishing date	2020-03-10
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2020.01.050
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Zs.A 1933: Show issues

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Article ; Online: Reply from authors: Transcarotid trumps transapical/direct aortic access for transcatheter aortic valve replacement-It's a no brainer!

Allen, Keith B / Chhatriwalla, Adnan K / Saxon, John / Hermiller, James / Heimansohn, David / Moainie, Sina / McKay, Raymond G / Cheema, Mohiuddin / Jones, Brandon / Hodson, Robert W / Korngold, Ethan / Kirker, Eric

The Journal of thoracic and cardiovascular surgery

2021 Volume 164, Issue 2, Page(s) e84–e86

MeSH term(s)	Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Stenosis/diagnostic imaging ; Aortic Valve Stenosis/surgery ; Humans ; Transcatheter Aortic Valve Replacement/adverse effects
Language	English
Publishing date	2021-02-23
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2021.01.032
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Article ; Online: Intrathoracic complications associated with trans-femoral transcatheter aortic valve replacement: Implications for emergency surgical preparedness.

Hodson, Robert W / Jin, Ruyun / Ring, Michael E / Gafoor, Sameer / Verburg, Shawnna / Lehr, Eric J / Spinelli, Kateri J

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

2019 Volume 96, Issue 3, Page(s) E369–E376

Abstract: Background: Intrathoracic complications (ITC) requiring emergency surgical intervention occur during transcatheter aortic valve replacement (TAVR).: Objectives: Characterize the incidence, outcomes and predictors of ITC in a large cohort of ... ...

Abstract	Background: Intrathoracic complications (ITC) requiring emergency surgical intervention occur during transcatheter aortic valve replacement (TAVR). Objectives: Characterize the incidence, outcomes and predictors of ITC in a large cohort of transfemoral (TF) TAVR cases over a 5 year period. Methods: Retrospective registry and chart review of all nonclinical trial TF-TAVR patients from seven centers within one hospital system from 2012-2016. ITC were defined as cardiac perforation, new or worsening pericardial effusion/tamponade, annular rupture, thoracic aortic injury, aortic valve dislodgement, and coronary artery occlusion. Procedural and 30-day outcomes and 1-year mortality were compared between ITC and no ITC patients. Multivariable logistic regression was used to identify predictors of ITC. Results: Over the study period, 1,581 patients had TF-TAVR and 68 ITC occurred in 46 patients (2.9%). The most common ITCs were pericardial effusion/tamponade (59%), cardiac perforation (33%), and valve dislodgement (33%). ITC rate did not decline over time (rate (95% confidence interval) for 2012 = 0% (0-8.8%), 2013 = 1.3% (0-7.2%), 2014 = 4.4% (2.2-8.0%), 2015 = 3.5% (2.0-5.6%), and 2016 = 2.4% (1.5-3.8%)). ITC patients had worse 1-year survival (ITC: 60.7% (45.1-73.1%), no ITC: 88.7% (87.0-90.3%); p < .001). The majority of ITC patient deaths occurred within the first 30 days. Multivariable models to predict ITC were not successful. Conclusions: ITC did not decline over time in our cohort. Predictors of ITC could not be identified. While these events are rare, they are associated with worse procedural outcomes and mortality. Heart teams should continue to be prepared for emergency intervention.
MeSH term(s)	Aged ; Aged, 80 and over ; Aortic Valve Stenosis/diagnosis ; Aortic Valve Stenosis/mortality ; Aortic Valve Stenosis/surgery ; Catheterization, Peripheral/adverse effects ; Catheterization, Peripheral/mortality ; Emergencies ; Female ; Femoral Artery ; Humans ; Incidence ; Intraoperative Complications/diagnosis ; Intraoperative Complications/mortality ; Intraoperative Complications/surgery ; Male ; Punctures ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sternotomy/adverse effects ; Sternotomy/mortality ; Time Factors ; Transcatheter Aortic Valve Replacement/adverse effects ; Transcatheter Aortic Valve Replacement/mortality ; Treatment Outcome ; United States
Language	English
Publishing date	2019-12-03
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	1459995-8
ISSN	1522-726X ; 1522-1946
ISSN (online)	1522-726X
ISSN	1522-1946
DOI	10.1002/ccd.28620
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Article ; Online: Transcarotid versus transthoracic access for transcatheter aortic valve replacement: A propensity-matched analysis.

The Journal of thoracic and cardiovascular surgery

2020 Volume 164, Issue 2, Page(s) 506–515

Abstract: Objective: Transcarotid access for transcatheter aortic valve replacement is emerging as an alternative to more traditional nonfemoral access options such as transapical or transaortic; however, comparative data are limited. The purpose of the study was ...

Abstract	Objective: Transcarotid access for transcatheter aortic valve replacement is emerging as an alternative to more traditional nonfemoral access options such as transapical or transaortic; however, comparative data are limited. The purpose of the study was to analyze outcomes after transcatheter aortic valve replacement using transcatheter compared with transthoracic (transapical/transaortic) access. Methods: The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry was queried for patients who underwent transcarotid, transapical, or transaortic transcatheter aortic valve replacement with the SAPIEN 3 (Edwards Lifesciences, Irvine, Calif) transcatheter heart valve between June 2015 and July 2019. Thirty-day unadjusted outcomes were evaluated, and propensity score matching and logistic regression were used to compare transcatheter access with transthoracic access. Results: In the propensity-matched analysis, 667 transcarotid transcatheter aortic valve replacement procedures were compared with 1334 transthoracic procedures. Transcarotid transcatheter aortic valve replacement was associated with lower mortality (4.2% vs 7.7%, P = .004), less new-onset atrial fibrillation (2.2% vs 12.1%, P < .0001), fewer readmissions at 30 days (9.8% vs 16.1%, P = .0006), shorter median length of stay (3.0 vs 6.0 days, P < .0001), shorter median intensive care unit stay (25 vs 47.2 hours, P < .0001), and greater 30-day Kansas City Cardiomyopathy Questionnaire score improvement from baseline (25.1 vs 20.8, P = .007). Stroke (4.3% vs 3.7%, P = .44) and major vascular complications (1.4% vs 1.9%, P = .40) were similar. Conclusions: Transcatheter aortic valve replacement using transcarotid access is associated with lower 30-day mortality, less atrial fibrillation, shorter intensive care unit and overall length of stay, fewer readmissions, greater improvement in Kansas City Cardiomyopathy Questionnaire scores, and no significant difference in stroke or major vascular complications compared with transthoracic access.
MeSH term(s)	Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Stenosis/diagnostic imaging ; Aortic Valve Stenosis/surgery ; Atrial Fibrillation/surgery ; Cardiomyopathies ; Humans ; Retrospective Studies ; Risk Factors ; Stroke/etiology ; Transcatheter Aortic Valve Replacement/methods ; Treatment Outcome
Language	English
Publishing date	2020-10-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2020.09.133
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Article ; Online: Transcarotid Versus Subclavian/Axillary Access for Transcatheter Aortic Valve Replacement With SAPIEN 3.

Kirker, Eric / Korngold, Ethan / Hodson, Robert W / Jones, Brandon M / McKay, Raymond / Cheema, Mohiuddin / Heimansohn, David / Moainie, Sina / Hermiller, James / Chatriwalla, Adnan / Saxon, John / Allen, Keith B

The Annals of thoracic surgery

2020 Volume 110, Issue 6, Page(s) 1892–1897

Abstract: Background: Subclavian/axillary (TAx) access has become the most frequently used alternative access route for transcatheter aortic valve replacement (TAVR). Transcarotid (TC) TAVR has grown in popularity recently. Comparative data between these 2 ... ...

Abstract	Background: Subclavian/axillary (TAx) access has become the most frequently used alternative access route for transcatheter aortic valve replacement (TAVR). Transcarotid (TC) TAVR has grown in popularity recently. Comparative data between these 2 contemporary access methods is lacking. Methods: Data were extracted from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry™ (June 2015 to October 2019) for patients undergoing TAVR by TC or TAx access with the SAPIEN 3 and SAPIEN 3 Ultra (Edwards Lifesciences, Irvine, CA) transcatheter heart valves. Procedural, index hospitalization, and 30-day outcomes were analyzed for TC vs TAx groups after 1:2 propensity matching of patient baseline characteristics. Results: The study included 3903 cases, of which 801 TC and 3102 TAx procedures were compared. After 1:2 propensity matching, TC TAVR was associated with similar 30-day mortality (4.3% vs 5.2%, P = .34) but a significantly lower risk of stroke (4.2% vs 7.4%; hazard ratio, 0.56; 95% confidence interval, 0.38-0.83; P = .003) compared with TAx access. Other outcomes that favored TC over TAx included shorter procedure time (117.0 vs 132.4 minutes; P < .001) and fluoroscopy time (16.6 vs 21.6 min; P < .001), lower contrast volume (78.5 vs 96.7 mL; P < .001), shorter length of stay in the intensive care unit (24.3 vs 25.0 hours; P = .02) and hospital (2.0 vs 3.0 days; P = .002), and more patients discharged to home (82.9% vs 74.6%; P < .001). Conclusions: TC TAVR is associated with similar mortality and a significant reduction in stroke compared with the TAx approach. If femoral access is precluded, TC may be a safe, or at times, preferred avenue of transcatheter valve delivery.
MeSH term(s)	Aged ; Aged, 80 and over ; Aortic Valve Stenosis/complications ; Aortic Valve Stenosis/mortality ; Aortic Valve Stenosis/surgery ; Cardiac Catheterization/adverse effects ; Cardiac Catheterization/methods ; Carotid Arteries ; Female ; Heart Valve Prosthesis ; Hospitalization ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Propensity Score ; Retrospective Studies ; Stroke/epidemiology ; Survival Rate ; Transcatheter Aortic Valve Replacement/adverse effects ; Transcatheter Aortic Valve Replacement/methods ; Treatment Outcome
Language	English
Publishing date	2020-07-24
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2020.05.141
Database	MEDical Literature Analysis and Retrieval System OnLINE

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