Alternative access for transcatheter aortic valve replacement in older adults

A collaborative study from France and United States

Abdulla A. Damluji, Magdalena Murman, Seunghwan Byun, Mauro Moscucci, Jon R Resar, Rani Hasan, Carlos E. Alfonso, Roger G. Carrillo, Donald B. Williams, Christopher C. Kwon, Peter W. Cho, Marina Dijos, Julien Peltan, Alan W. Heldman, Mauricio G. Cohen, Lionel Leroux

Research output: Contribution to journalArticle

Abstract

Background: We examined the outcomes of older adults undergoing nontrans-femoral (non-TF) transcatheter aortic valve replacement (TAVR) procedures including trans-apical (TA), trans-aortic (TAo), trans-subclavian (TSub), and trans-carotid (TCa) techniques. Methods and Results: This is an observational study of all consecutive older patients who underwent non-TF TAVR for symptomatic severe AS with Edwards Sapien (ES), Medtronic CoreValve, ES3 or Lotus Valve at three centers in France and the United States from 04/2008 to 02/2017. Baseline characteristics and clinical outcomes were defined according to VARC-2 criteria. Of 857 patients who received TAVR, 172 (20%) had an alternative access procedure. Of these, 45 (26%) were TA, 67 (39%) TAo, 17 (10%) TSub, and 43 (25%) TCa procedures. The preference for non-TF access site was different between the two countries (US: TA 39%, TAo 52%, TSub 9%; TCa 0% vs. France: TA 9%, TAo 23%, TSub 11%, and TCa 57%, P-value<.001). Most patients who underwent TAo TAVR were older women (median age: TA 82, TAo 84, TSub 81, TCa 81, P-value=0.043; female gender: TA 32 (27%), TAo 30 (55%), TSub 10 (41%), TCa 27 (37%), P-value=.021). The predicted Society of Thoracic Surgery risk of mortality was similar among groups (TA 7%, TAo 7%, TSub 6%, TCa 7%, P-value= .738). No differences were observed in the frequency of para-valvular leak, intra-procedural bleeding, vascular complications, conversion to open-heart surgery, or development of acute kidney injury. The highest in-hospital mortality was observed in the TAo group (TA 2%, TAo 15%, TSub 0%, TCa 2%, P-value=.014). However, hospital length of stay, one-month, and one-year mortality were similar among non-TF techniques. Conclusion: Although regional differences exist in the choice of alternative access techniques, centers with high technical expertise can provide a safe alternative to traditional TF TAVR. TAo TAVR was associated with higher in-hospital mortality than other non-TF approaches, and this may have reflected patient rather than procedural factors. All alternative access techniques had similar mortality rates and clinical outcomes at one-year follow-up. Trans-carotid access is safe and feasible compared to other non-TF access techniques.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2018

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Thigh
France
Hospital Mortality
Thoracic Surgery
Mortality
Length of Stay
Professional Competence
Conversion to Open Surgery
Acute Kidney Injury
Observational Studies
Blood Vessels
Transcatheter Aortic Valve Replacement
Hemorrhage

Keywords

  • Aortic valve stenosis
  • Outcomes
  • Transcatheter aortic valve replacement
  • Vascular access

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Alternative access for transcatheter aortic valve replacement in older adults : A collaborative study from France and United States. / Damluji, Abdulla A.; Murman, Magdalena; Byun, Seunghwan; Moscucci, Mauro; Resar, Jon R; Hasan, Rani; Alfonso, Carlos E.; Carrillo, Roger G.; Williams, Donald B.; Kwon, Christopher C.; Cho, Peter W.; Dijos, Marina; Peltan, Julien; Heldman, Alan W.; Cohen, Mauricio G.; Leroux, Lionel.

In: Catheterization and Cardiovascular Interventions, 01.01.2018.

Research output: Contribution to journalArticle

Damluji, AA, Murman, M, Byun, S, Moscucci, M, Resar, JR, Hasan, R, Alfonso, CE, Carrillo, RG, Williams, DB, Kwon, CC, Cho, PW, Dijos, M, Peltan, J, Heldman, AW, Cohen, MG & Leroux, L 2018, 'Alternative access for transcatheter aortic valve replacement in older adults: A collaborative study from France and United States', Catheterization and Cardiovascular Interventions. https://doi.org/10.1002/ccd.27690
Damluji, Abdulla A. ; Murman, Magdalena ; Byun, Seunghwan ; Moscucci, Mauro ; Resar, Jon R ; Hasan, Rani ; Alfonso, Carlos E. ; Carrillo, Roger G. ; Williams, Donald B. ; Kwon, Christopher C. ; Cho, Peter W. ; Dijos, Marina ; Peltan, Julien ; Heldman, Alan W. ; Cohen, Mauricio G. ; Leroux, Lionel. / Alternative access for transcatheter aortic valve replacement in older adults : A collaborative study from France and United States. In: Catheterization and Cardiovascular Interventions. 2018.
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abstract = "Background: We examined the outcomes of older adults undergoing nontrans-femoral (non-TF) transcatheter aortic valve replacement (TAVR) procedures including trans-apical (TA), trans-aortic (TAo), trans-subclavian (TSub), and trans-carotid (TCa) techniques. Methods and Results: This is an observational study of all consecutive older patients who underwent non-TF TAVR for symptomatic severe AS with Edwards Sapien (ES), Medtronic CoreValve, ES3 or Lotus Valve at three centers in France and the United States from 04/2008 to 02/2017. Baseline characteristics and clinical outcomes were defined according to VARC-2 criteria. Of 857 patients who received TAVR, 172 (20{\%}) had an alternative access procedure. Of these, 45 (26{\%}) were TA, 67 (39{\%}) TAo, 17 (10{\%}) TSub, and 43 (25{\%}) TCa procedures. The preference for non-TF access site was different between the two countries (US: TA 39{\%}, TAo 52{\%}, TSub 9{\%}; TCa 0{\%} vs. France: TA 9{\%}, TAo 23{\%}, TSub 11{\%}, and TCa 57{\%}, P-value<.001). Most patients who underwent TAo TAVR were older women (median age: TA 82, TAo 84, TSub 81, TCa 81, P-value=0.043; female gender: TA 32 (27{\%}), TAo 30 (55{\%}), TSub 10 (41{\%}), TCa 27 (37{\%}), P-value=.021). The predicted Society of Thoracic Surgery risk of mortality was similar among groups (TA 7{\%}, TAo 7{\%}, TSub 6{\%}, TCa 7{\%}, P-value= .738). No differences were observed in the frequency of para-valvular leak, intra-procedural bleeding, vascular complications, conversion to open-heart surgery, or development of acute kidney injury. The highest in-hospital mortality was observed in the TAo group (TA 2{\%}, TAo 15{\%}, TSub 0{\%}, TCa 2{\%}, P-value=.014). However, hospital length of stay, one-month, and one-year mortality were similar among non-TF techniques. Conclusion: Although regional differences exist in the choice of alternative access techniques, centers with high technical expertise can provide a safe alternative to traditional TF TAVR. TAo TAVR was associated with higher in-hospital mortality than other non-TF approaches, and this may have reflected patient rather than procedural factors. All alternative access techniques had similar mortality rates and clinical outcomes at one-year follow-up. Trans-carotid access is safe and feasible compared to other non-TF access techniques.",
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author = "Damluji, {Abdulla A.} and Magdalena Murman and Seunghwan Byun and Mauro Moscucci and Resar, {Jon R} and Rani Hasan and Alfonso, {Carlos E.} and Carrillo, {Roger G.} and Williams, {Donald B.} and Kwon, {Christopher C.} and Cho, {Peter W.} and Marina Dijos and Julien Peltan and Heldman, {Alan W.} and Cohen, {Mauricio G.} and Lionel Leroux",
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TY - JOUR

T1 - Alternative access for transcatheter aortic valve replacement in older adults

T2 - A collaborative study from France and United States

AU - Damluji, Abdulla A.

AU - Murman, Magdalena

AU - Byun, Seunghwan

AU - Moscucci, Mauro

AU - Resar, Jon R

AU - Hasan, Rani

AU - Alfonso, Carlos E.

AU - Carrillo, Roger G.

AU - Williams, Donald B.

AU - Kwon, Christopher C.

AU - Cho, Peter W.

AU - Dijos, Marina

AU - Peltan, Julien

AU - Heldman, Alan W.

AU - Cohen, Mauricio G.

AU - Leroux, Lionel

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: We examined the outcomes of older adults undergoing nontrans-femoral (non-TF) transcatheter aortic valve replacement (TAVR) procedures including trans-apical (TA), trans-aortic (TAo), trans-subclavian (TSub), and trans-carotid (TCa) techniques. Methods and Results: This is an observational study of all consecutive older patients who underwent non-TF TAVR for symptomatic severe AS with Edwards Sapien (ES), Medtronic CoreValve, ES3 or Lotus Valve at three centers in France and the United States from 04/2008 to 02/2017. Baseline characteristics and clinical outcomes were defined according to VARC-2 criteria. Of 857 patients who received TAVR, 172 (20%) had an alternative access procedure. Of these, 45 (26%) were TA, 67 (39%) TAo, 17 (10%) TSub, and 43 (25%) TCa procedures. The preference for non-TF access site was different between the two countries (US: TA 39%, TAo 52%, TSub 9%; TCa 0% vs. France: TA 9%, TAo 23%, TSub 11%, and TCa 57%, P-value<.001). Most patients who underwent TAo TAVR were older women (median age: TA 82, TAo 84, TSub 81, TCa 81, P-value=0.043; female gender: TA 32 (27%), TAo 30 (55%), TSub 10 (41%), TCa 27 (37%), P-value=.021). The predicted Society of Thoracic Surgery risk of mortality was similar among groups (TA 7%, TAo 7%, TSub 6%, TCa 7%, P-value= .738). No differences were observed in the frequency of para-valvular leak, intra-procedural bleeding, vascular complications, conversion to open-heart surgery, or development of acute kidney injury. The highest in-hospital mortality was observed in the TAo group (TA 2%, TAo 15%, TSub 0%, TCa 2%, P-value=.014). However, hospital length of stay, one-month, and one-year mortality were similar among non-TF techniques. Conclusion: Although regional differences exist in the choice of alternative access techniques, centers with high technical expertise can provide a safe alternative to traditional TF TAVR. TAo TAVR was associated with higher in-hospital mortality than other non-TF approaches, and this may have reflected patient rather than procedural factors. All alternative access techniques had similar mortality rates and clinical outcomes at one-year follow-up. Trans-carotid access is safe and feasible compared to other non-TF access techniques.

AB - Background: We examined the outcomes of older adults undergoing nontrans-femoral (non-TF) transcatheter aortic valve replacement (TAVR) procedures including trans-apical (TA), trans-aortic (TAo), trans-subclavian (TSub), and trans-carotid (TCa) techniques. Methods and Results: This is an observational study of all consecutive older patients who underwent non-TF TAVR for symptomatic severe AS with Edwards Sapien (ES), Medtronic CoreValve, ES3 or Lotus Valve at three centers in France and the United States from 04/2008 to 02/2017. Baseline characteristics and clinical outcomes were defined according to VARC-2 criteria. Of 857 patients who received TAVR, 172 (20%) had an alternative access procedure. Of these, 45 (26%) were TA, 67 (39%) TAo, 17 (10%) TSub, and 43 (25%) TCa procedures. The preference for non-TF access site was different between the two countries (US: TA 39%, TAo 52%, TSub 9%; TCa 0% vs. France: TA 9%, TAo 23%, TSub 11%, and TCa 57%, P-value<.001). Most patients who underwent TAo TAVR were older women (median age: TA 82, TAo 84, TSub 81, TCa 81, P-value=0.043; female gender: TA 32 (27%), TAo 30 (55%), TSub 10 (41%), TCa 27 (37%), P-value=.021). The predicted Society of Thoracic Surgery risk of mortality was similar among groups (TA 7%, TAo 7%, TSub 6%, TCa 7%, P-value= .738). No differences were observed in the frequency of para-valvular leak, intra-procedural bleeding, vascular complications, conversion to open-heart surgery, or development of acute kidney injury. The highest in-hospital mortality was observed in the TAo group (TA 2%, TAo 15%, TSub 0%, TCa 2%, P-value=.014). However, hospital length of stay, one-month, and one-year mortality were similar among non-TF techniques. Conclusion: Although regional differences exist in the choice of alternative access techniques, centers with high technical expertise can provide a safe alternative to traditional TF TAVR. TAo TAVR was associated with higher in-hospital mortality than other non-TF approaches, and this may have reflected patient rather than procedural factors. All alternative access techniques had similar mortality rates and clinical outcomes at one-year follow-up. Trans-carotid access is safe and feasible compared to other non-TF access techniques.

KW - Aortic valve stenosis

KW - Outcomes

KW - Transcatheter aortic valve replacement

KW - Vascular access

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