Use of Transaortic, Transapical, and Transcarotid Transcatheter Aortic Valve Replacement in Inoperable Patients
| Autor: | Patricia Keegan, Robert A. Guyton, Tom C. Nguyen, Peter C. Block, Chandan Devireddy, Soumya Neravetla, James Stewart, Patrick D. Kilgo, Vasilis Babaliaros, Kreton Mavromatis, Rebecca L. Gunter, Bradley G. Leshnower, Amy Simone, John D. Merlino, Stamatios Lerakis, Vinod H. Thourani |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment law.invention Cohort Studies Valve replacement Aortic valve replacement law medicine Humans Stroke Aorta Dialysis Aged Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation Ejection fraction business.industry Heart Aortic Valve Stenosis medicine.disease Intensive care unit Surgery Stenosis Carotid Arteries Heart failure Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 96:1349-1357 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2013.05.068 |
| Popis: | Background Transcatheter aortic valve replacement (TAVR) is an effective treatment in patients with severe aortic stenosis unsuitable for surgical aortic valve replacement (SAVR). This study evaluated the early experience with the posttrial application of TAVR, with specific focus on non-transfemoral (TF) access. Methods All patients who underwent posttrial TAVR at Emory University from November 2011 to April 2012 were reviewed. During this time, 44 posttrial TAVRs were performed: TF in 18, transapical in 11, transaortic in 12, and transcarotid in 3. Results A total of 40.9% of all patients were candidates for TF implantation. Mean age was 78.2 ± 11.3 years, and 34.1% were women. Mean ejection fraction was 0.463 ± 0.164, and 90.2% had New York Heart Association class III to IV heart failure. Fifty percent were diabetic, 27.3% had moderate to severe chronic obstructive pulmonary disease, and 20.5% had a prior stroke. The mean creatinine was 1.63 ± 1.74 mg/dL, 9.1% required preoperative dialysis, and 61.4% had undergone prior cardiac operations. No patients had postoperative myocardial infarction, stroke, or required new dialysis. Intraoperative vascular complications occurred in 11.4%. No patient had more than mild perivalvular leak by transthoracic echocardiography at discharge. Mean postoperative ventilator time was 17.8 ± 40.1 hours. Intensive care unit length of stay was 58.0 ± 67.0 hours. Postoperative hospital length of stay was 6.1 ± 4.7 days. The 30-day mortality was 6.8% (3 of 44) for all patients, despite a mean The Society of Thoracic Surgeons Predicted Risk of Mortality score of 12.6. Conclusions Less than half of patients deemed appropriate for posttrial TAVR were candidates for TF implantation. The use of all available access routes leads to excellent outcomes in patients deemed inoperable. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|