The Fate of Transcaval Access Tracts
| Autor: | Bradley G. Leshnower, Kamran I. Muhammad, Toby Rogers, Adam Greenbaum, Jaffar M. Khan, Vinod H. Thourani, Xin Tian, Gaetano Paone, Robert J. Lederman, Robert A. Leonardi, Marcus Y. Chen, Annette M. Stine, Vasilis Babaliaros |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Percutaneous Transcatheter aortic business.industry Fistula medicine.medical_treatment 030204 cardiovascular system & hematology medicine.disease Surgery 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Valve replacement Heart failure medicine 030212 general & internal medicine Abdominal computed tomography Core laboratory Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | JACC: Cardiovascular Interventions. 12:448-456 |
| ISSN: | 1936-8798 |
| Popis: | Objectives The authors investigated 1-year outcomes after transcaval access and closure for transcatheter aortic valve replacement (TAVR), using commercially available nitinol cardiac occluders off-label. Background Transcaval access is a fully percutaneous nonfemoral artery route for TAVR. The intermediate-term fate of transcaval access tracts is not known. Methods The authors performed a prospective, multicenter, independently adjudicated trial of transcaval access, using Amplatzer nitinol cardiac occluders (Abbott Vascular, Minneapolis, Minnesota), among subjects without traditional transthoracic (transapical or transaortic) access options. One-year clinical follow-up included core laboratory analysis of serial abdominal computed tomography (CT). Results 100 subjects were enrolled. Twelve-month mortality was 29%. After discharge, there were no vascular complications of transcaval access. Among 83 evaluable CT scans after 12 months, 77 of fistulas (93%) were proven occluded, and only 1 was proven patent. Fistula patency was not associated with overall survival (p = 0.37), nor with heart failure admissions (15% if patent vs. 23% if occluded; p = 0.30). There were no cases of occluder fracture or migration or visceral injury. Conclusions Results are reassuring 1 year after transcaval TAVR and closure using permeable nitinol occluders off-label. There were no late major vascular complications. CT demonstrated spontaneous closure of almost all fistulas. Results may be different in a lower-risk cohort, with increased operator experience, and using a dedicated transcaval closure device. (Transcaval Access for Transcatheter Aortic Valve Replacement in People With No Good Options for Aortic Access; NCT02280824) |
| Databáze: | OpenAIRE |
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