TY - JOUR
T1 - A less-invasive totally-endovascular (LITE) technique for trans-femoral transcatheter aortic valve replacement
AU - Burzotta, Francesco
AU - Aurigemma, Cristina
AU - Romagnoli, Enrico
AU - Shoeib, Osama
AU - Russo, Giulio
AU - Zambrano, Aniello
AU - Verdirosi, Diana
AU - Leone, Antonio Maria
AU - Bruno, Piergiorgio
AU - Trani, Carlo
PY - 2020
Y1 - 2020
N2 - Objectives: To describe and report the results of an original technique for trans-femoral (TF) transcatheter-aortic-valve-replacement (TAVR). Background: TF approach represents the commonest TAVR technique. The best technique for TF-TAVR is not recognized. Methods: We developed a less-invasive totally-endovascular (LITE) technique for TF-TAVR. The key aspects are: precise TAVR access puncture using angiographic-guidewire-ultrasound guidance radial approach as the “secondary access” (to guide valve positioning, to check femoral-access hemostasis and to manage eventual access-site complications) non-invasive pacing (by retrograde left ventricle stimulation or by definitive pace-maker external programmer). The LITE technique has been systematically adopted at our Institution. Procedure details, complications and clinical events occurring during hospitalization were prospectively recorded. Major vascular complications and life-threatening or major bleedings were the primary study end-points. Results: A total of 153 consecutive patients referred for TF-TAVR were approached using the LITE technique. Mean predicted surgical operative mortality was 4.9% and mean TAVR predicted mortality was 3.9%. In 132 (86.3%) patients, TAVR was completed without the need for additional femoral artery access or transvenous temporary pace-maker implantation. Major vascular complications occurred in 2 (1.3%), life-threatening or major bleedings occurred in 4 (2.6%) patients. All-cause death occurred in 3 patients (2.0%). Conclusions: TF-TAVR according to LITE technique is feasible and is associated with very low rates of vascular or bleeding complications.
AB - Objectives: To describe and report the results of an original technique for trans-femoral (TF) transcatheter-aortic-valve-replacement (TAVR). Background: TF approach represents the commonest TAVR technique. The best technique for TF-TAVR is not recognized. Methods: We developed a less-invasive totally-endovascular (LITE) technique for TF-TAVR. The key aspects are: precise TAVR access puncture using angiographic-guidewire-ultrasound guidance radial approach as the “secondary access” (to guide valve positioning, to check femoral-access hemostasis and to manage eventual access-site complications) non-invasive pacing (by retrograde left ventricle stimulation or by definitive pace-maker external programmer). The LITE technique has been systematically adopted at our Institution. Procedure details, complications and clinical events occurring during hospitalization were prospectively recorded. Major vascular complications and life-threatening or major bleedings were the primary study end-points. Results: A total of 153 consecutive patients referred for TF-TAVR were approached using the LITE technique. Mean predicted surgical operative mortality was 4.9% and mean TAVR predicted mortality was 3.9%. In 132 (86.3%) patients, TAVR was completed without the need for additional femoral artery access or transvenous temporary pace-maker implantation. Major vascular complications occurred in 2 (1.3%), life-threatening or major bleedings occurred in 4 (2.6%) patients. All-cause death occurred in 3 patients (2.0%). Conclusions: TF-TAVR according to LITE technique is feasible and is associated with very low rates of vascular or bleeding complications.
KW - endovascular interventions
KW - personalized medicine
KW - temporary pace-maker
KW - trans-femoral approach
KW - trans-radial approach
KW - transcatheter-aortic-valve-replacement
KW - endovascular interventions
KW - personalized medicine
KW - temporary pace-maker
KW - trans-femoral approach
KW - trans-radial approach
KW - transcatheter-aortic-valve-replacement
UR - http://hdl.handle.net/10807/152870
U2 - 10.1002/ccd.28697
DO - 10.1002/ccd.28697
M3 - Article
SN - 1522-1946
VL - 2020
SP - N/A-N/A
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
ER -