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Trans-subclavian Transcatheter Aortic Valve Implantation: the second-line access
Session:
Posters (Sessão 6 - Écran 8) - Intervenção Coronária e Estrutural 5 - Intervenção Valvular
Speaker:
André Grazina
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
André Grazina; Inês Rodrigues; Tiago Mendonça; Alexandra Castelo; Rita Teixeira; Bárbara Teixeira; Sofia Jacinto; Ruben Ramos; António Fiarresga; Lino Patrício; Duarte Cacela; Rui Cruz Ferreira
Abstract
<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:"Arial Narrow",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:"Arial Narrow",sans-serif"><span style="color:black">Transfemoral (TF) 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 of the aorto-iliac-femoral axis. In such cases trans-subclavian (TS) access 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:"Arial Narrow",sans-serif"><span style="color:black">Objectives:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black"> This analysis aims to describe the initial experience of TS TAVI in a tertiary center, regarding technique safety and outcomes. </span></span></span></span></span></p> <h1 style="text-align:justify"><span style="font-size:24pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black"><strong>Methods:</strong> </span></span></span><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">Retrospective descriptive analysis of the patients submitted to TS TAVI in a single center.</span></span></span> <span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",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:"Arial Narrow",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:"Arial Narrow",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:"Arial Narrow",sans-serif"><span style="color:black">535</span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black"> TAVI procedures were performed including 20 patients (mean age 79.0 ± 8.0 y/o, 80% male) who underwent TS TAVI (70% with surgical access, 30% with percutaneous). Regarding the latter baseline characteristics (table 1), it was noted a mean Euroscore II and STS scores of 7.45 and 5.48, respectively, obstructive </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">coronary artery disease in 55% (previous myocardial infraction in 25%, previous CABG in 10%), symptomatic peripheral artery disease in 65%, previous stroke in 10%, significative renal dysfunction (GFR <60ml/min/m<sup>2</sup>) in 70% and high frailty scores</span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">. Basal NYHA class was 3.0 ± 0.7. VARC-2 procedure success rate was 90% (one intra-procedural death after left ventricle perforation and one patient with post-procedural moderate periprosthetic regurgitation) versus 92.4% in the TF population. In-hospital mortality was 15% (one intra-procedural death, one due to cardiac tamponade 3 days after TAVI and another death due to a hypoxemic respiratory infection 7 days after TAVI). One-year mortality rate was 30% which compares unfavorably with the 16.1% one-year mortality in the TF TAVI population. These other 3 patients died with a severe SARS-CoV2 infection, an acute renal failure and a mesenteric ischemia, respectively. Two minor, non-disabling strokes were noted during hospitalization (10% versus 5.3% in the TF population) and none after discharge in the first year. No other major vascular or access related complications were noted (10% versus 5.5% in the TF group). No peri-procedure or first year myocardial infarctions occurred (0.2% in the TF population). Seven patients required permanent pacemaker implantation after TAVI (37% versus 21.5% in TF population), all during hospitalization. </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">No prosthetic dysfunction, endocarditis or thrombosis occurred in the first year. </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">There was significant symptomatic improvement at one-year follow-up (mean NYHA class of </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">1.3 </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">vs 3.0 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:"Arial Narrow",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:"Arial Narrow",sans-serif"><span style="color:black"> This analysis describes <em>real-world</em> and initial experience with TS TAVI in high and very high-risk patients, regarding the technique safety and outcomes. In selected patients with high-risk femoral access, trans-subclavian TAVI may be a reasonable alternative. </span></span></span></span></span></span></p>
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