Trans-axillary versus trans-aortic approach for transcatheter aortic valve implantation with corevalve revalving system

insights from multicentre experience

Claudia Fiorina, Giuseppe Bruschi, Luca Testa, Marco Di Carlo, Federico De Marco, Giuseppe Coletti, Stefano Bonardelli, Marianna Adamo, Salvatore Curello, Giovanni Scioti, Paolo Panisi, Francesco Bedogni, Anna Sonia Petronio, Federica Ettori

Research output: Contribution to journalArticle

Abstract

BACKGROUND: About one-third of candidates for transcatheter aortic valve implantation (TAVI) suffer from severe peripheral artery disease, making the routine femoral approach difficult or impossible. Aim was to compare the trans-axillary (TAx) and the trans-aortic (TAo) route for TAVI with Medtronic CoreValve Revalving System (CRS).

METHODS: 242 (23%) out of 1049 consecutive TAVI with 18F CRS were treated in 4 high-volume Italian Centre through TAx (61%) and TAo (39%).

RESULTS: The devices success was similar (p=0.16) with a trend to a lower incidence of significant paravalvular leak (6% vs 14%, p=0.07) and a significant reduction of permanent pacemaker (PPM) implantation (13% vs 34%, p=0.017) in the TAo. However, this route showed a higher incidence of acute kidney injury (p=0.016) and a longer hospital stay after the index procedure (days 10 [8-14] vs 8 [7-12], p=0.001). By a multivariate analysis the vascular access is an independent predictor for a longer hospital stay (TAo route; OR= 0.37, 95%CI 0.18-0.75; p=0.006) and for PPM implantation (TAx route; OR= 3.7, 95% CI 1.2-10.8; p=0.017).

CONCLUSION: Although the higher clinical risk profile of trans-aortic population, the TAo approach showed an equally high device success with similar 30-day safety and 1year efficacy, compared to TAx route. However, due to non procedure-specific complications post-TAo TAVI, this route requires a specialized postoperative care and the treatment of patients in highly specialized and experienced centres.

Original languageEnglish
JournalJournal of Cardiovascular Surgery
Publication statusE-pub ahead of print - Oct 4 2016

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Length of Stay
Equipment and Supplies
Postoperative Care
Peripheral Arterial Disease
Incidence
Thigh
Acute Kidney Injury
Blood Vessels
Multivariate Analysis
Safety
Transcatheter Aortic Valve Replacement
Population
Therapeutics

Keywords

  • Journal Article

Cite this

Trans-axillary versus trans-aortic approach for transcatheter aortic valve implantation with corevalve revalving system : insights from multicentre experience. / Fiorina, Claudia; Bruschi, Giuseppe; Testa, Luca; Di Carlo, Marco; De Marco, Federico; Coletti, Giuseppe; Bonardelli, Stefano; Adamo, Marianna; Curello, Salvatore; Scioti, Giovanni; Panisi, Paolo; Bedogni, Francesco; Petronio, Anna Sonia; Ettori, Federica.

In: Journal of Cardiovascular Surgery, 04.10.2016.

Research output: Contribution to journalArticle

Fiorina, Claudia ; Bruschi, Giuseppe ; Testa, Luca ; Di Carlo, Marco ; De Marco, Federico ; Coletti, Giuseppe ; Bonardelli, Stefano ; Adamo, Marianna ; Curello, Salvatore ; Scioti, Giovanni ; Panisi, Paolo ; Bedogni, Francesco ; Petronio, Anna Sonia ; Ettori, Federica. / Trans-axillary versus trans-aortic approach for transcatheter aortic valve implantation with corevalve revalving system : insights from multicentre experience. In: Journal of Cardiovascular Surgery. 2016.
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abstract = "BACKGROUND: About one-third of candidates for transcatheter aortic valve implantation (TAVI) suffer from severe peripheral artery disease, making the routine femoral approach difficult or impossible. Aim was to compare the trans-axillary (TAx) and the trans-aortic (TAo) route for TAVI with Medtronic CoreValve Revalving System (CRS).METHODS: 242 (23{\%}) out of 1049 consecutive TAVI with 18F CRS were treated in 4 high-volume Italian Centre through TAx (61{\%}) and TAo (39{\%}).RESULTS: The devices success was similar (p=0.16) with a trend to a lower incidence of significant paravalvular leak (6{\%} vs 14{\%}, p=0.07) and a significant reduction of permanent pacemaker (PPM) implantation (13{\%} vs 34{\%}, p=0.017) in the TAo. However, this route showed a higher incidence of acute kidney injury (p=0.016) and a longer hospital stay after the index procedure (days 10 [8-14] vs 8 [7-12], p=0.001). By a multivariate analysis the vascular access is an independent predictor for a longer hospital stay (TAo route; OR= 0.37, 95{\%}CI 0.18-0.75; p=0.006) and for PPM implantation (TAx route; OR= 3.7, 95{\%} CI 1.2-10.8; p=0.017).CONCLUSION: Although the higher clinical risk profile of trans-aortic population, the TAo approach showed an equally high device success with similar 30-day safety and 1year efficacy, compared to TAx route. However, due to non procedure-specific complications post-TAo TAVI, this route requires a specialized postoperative care and the treatment of patients in highly specialized and experienced centres.",
keywords = "Journal Article",
author = "Claudia Fiorina and Giuseppe Bruschi and Luca Testa and {Di Carlo}, Marco and {De Marco}, Federico and Giuseppe Coletti and Stefano Bonardelli and Marianna Adamo and Salvatore Curello and Giovanni Scioti and Paolo Panisi and Francesco Bedogni and Petronio, {Anna Sonia} and Federica Ettori",
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TY - JOUR

T1 - Trans-axillary versus trans-aortic approach for transcatheter aortic valve implantation with corevalve revalving system

T2 - insights from multicentre experience

AU - Fiorina, Claudia

AU - Bruschi, Giuseppe

AU - Testa, Luca

AU - Di Carlo, Marco

AU - De Marco, Federico

AU - Coletti, Giuseppe

AU - Bonardelli, Stefano

AU - Adamo, Marianna

AU - Curello, Salvatore

AU - Scioti, Giovanni

AU - Panisi, Paolo

AU - Bedogni, Francesco

AU - Petronio, Anna Sonia

AU - Ettori, Federica

PY - 2016/10/4

Y1 - 2016/10/4

N2 - BACKGROUND: About one-third of candidates for transcatheter aortic valve implantation (TAVI) suffer from severe peripheral artery disease, making the routine femoral approach difficult or impossible. Aim was to compare the trans-axillary (TAx) and the trans-aortic (TAo) route for TAVI with Medtronic CoreValve Revalving System (CRS).METHODS: 242 (23%) out of 1049 consecutive TAVI with 18F CRS were treated in 4 high-volume Italian Centre through TAx (61%) and TAo (39%).RESULTS: The devices success was similar (p=0.16) with a trend to a lower incidence of significant paravalvular leak (6% vs 14%, p=0.07) and a significant reduction of permanent pacemaker (PPM) implantation (13% vs 34%, p=0.017) in the TAo. However, this route showed a higher incidence of acute kidney injury (p=0.016) and a longer hospital stay after the index procedure (days 10 [8-14] vs 8 [7-12], p=0.001). By a multivariate analysis the vascular access is an independent predictor for a longer hospital stay (TAo route; OR= 0.37, 95%CI 0.18-0.75; p=0.006) and for PPM implantation (TAx route; OR= 3.7, 95% CI 1.2-10.8; p=0.017).CONCLUSION: Although the higher clinical risk profile of trans-aortic population, the TAo approach showed an equally high device success with similar 30-day safety and 1year efficacy, compared to TAx route. However, due to non procedure-specific complications post-TAo TAVI, this route requires a specialized postoperative care and the treatment of patients in highly specialized and experienced centres.

AB - BACKGROUND: About one-third of candidates for transcatheter aortic valve implantation (TAVI) suffer from severe peripheral artery disease, making the routine femoral approach difficult or impossible. Aim was to compare the trans-axillary (TAx) and the trans-aortic (TAo) route for TAVI with Medtronic CoreValve Revalving System (CRS).METHODS: 242 (23%) out of 1049 consecutive TAVI with 18F CRS were treated in 4 high-volume Italian Centre through TAx (61%) and TAo (39%).RESULTS: The devices success was similar (p=0.16) with a trend to a lower incidence of significant paravalvular leak (6% vs 14%, p=0.07) and a significant reduction of permanent pacemaker (PPM) implantation (13% vs 34%, p=0.017) in the TAo. However, this route showed a higher incidence of acute kidney injury (p=0.016) and a longer hospital stay after the index procedure (days 10 [8-14] vs 8 [7-12], p=0.001). By a multivariate analysis the vascular access is an independent predictor for a longer hospital stay (TAo route; OR= 0.37, 95%CI 0.18-0.75; p=0.006) and for PPM implantation (TAx route; OR= 3.7, 95% CI 1.2-10.8; p=0.017).CONCLUSION: Although the higher clinical risk profile of trans-aortic population, the TAo approach showed an equally high device success with similar 30-day safety and 1year efficacy, compared to TAx route. However, due to non procedure-specific complications post-TAo TAVI, this route requires a specialized postoperative care and the treatment of patients in highly specialized and experienced centres.

KW - Journal Article

M3 - Article

JO - Journal of Cardiovascular Surgery

JF - Journal of Cardiovascular Surgery

SN - 0021-9509

ER -