SPC365

Transcaval Transcatheter Aortic Valve Implantation: an alternative

Session: CO 24 - Interventional Cardiology -TAVI
Speaker: André Grazina

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: André Grazina; Alexandra Castelo; Duarte Cacela; Lino Patrício ; António Fiarresga; Ruben Ramos; Tiago Mendonça; Dra. Inês Rodrigues; Isabel Gonçalves Machado Cardoso; Rui Cruz Ferreira
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Introduction:</span></span></span></strong> <span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Transfemoral access is widely accepted as the preferential route for transcatheter aortic valve implantation (TAVI). However, in some patients this is not possible because of severe peripheral artery disease. In such cases transcaval access (TCv) TAVI is an option. </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Objectives:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> This analysis aims to describe the initial experience of TCv TAVI procedure in a tertiary center. </span></span></span></span></span></p>

<h1 style="text-align:justify"><span style="font-size:24pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"><strong>Methods:</strong> </span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Retrospective descriptive analysis of the patients submitted to TCv TAVI in a single center.</span></span></span> <span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Baseline characteristics, procedure data and 1-year outcomes were noted according to the Valve Academic Research Consortium-2 (VARC-2).</span></span></span></span></span></h1>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Results:</span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> During the study period, </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">493</span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> TAVI procedures were performed including 10 patients (mean age 77.9 y/o, 80% male) who underwent TCv TAVI. In the latter, average Euroscore II and STS score were 8.56 and 4.81, respectively, obstructive </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">coronary artery disease was present in 50%, previous CABG in 30%, symptomatic peripheral artery disease in 50%, previous stroke in 50% and high frailty scores</span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">. VARC-2 procedure success rate was 100%. The average duration of hospitalization after TCv TAVI was 5.9 days </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">(vs 10.4 in the overall TAVI population)</span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">. In-hospital mortality was 20% (one patient with hemorrhagic shock after upper gastrointestinal bleeding and another with cardiac arrest of indeterminate cause). One-year mortality rate was 30% (one patient died in the first year of follow-up because of acute decompensated heart failure), which compares unfavorably with the 13% one-year mortality in the overall TAVI population. One non-disabling stroke was noted during hospitalization and none after discharge in the first year. One major vascular complication, with a stent implantation in the infra-renal abdominal aorta occurred during hospitalization. One pacemaker was implanted in the first year, none during the hospitalization. No peri-procedure or first year myocardial infarctions occurred. No prosthetic dysfunction, endocarditis or thrombosis occurred in the first year. There was significant symptomatic improvement at one-year follow-up (average NYHA class of 1.5 vs 2.7 preprocedural). </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Conclusions:</span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> This analysis describes <em>real-world</em> and initial experience with TCv TAVI in high and very high-risk patients. In selected patients with high-risk femoral access, transcaval TAVI may be a reasonable alternative. </span></span></span></span></span></span></p>