High-risk patients with inoperative aortic stenosis: use of transapical, transaortic, and transcarotid techniques

Vinod H Thourani; Chun Li; Chandan Devireddy; Hanna A Jensen; Patrick Kilgo; Bradley G Leshnower; Kreton Mavromatis; Eric L Sarin; Tom C Nguyen; Mihir Kanitkar; Robert A Guyton; Peter C Block; Amanda L Maas; Amy Simone; Patricia Keegan; John Merlino; James P Stewart; Stamatios Lerakis; Vasilis Babaliaros

doi:10.1016/j.athoracsur.2014.10.012

High-risk patients with inoperative aortic stenosis: use of transapical, transaortic, and transcarotid techniques

Vinod H Thourani
, Chun Li
, Chandan Devireddy
, Hanna A Jensen
, Patrick Kilgo
, Bradley G Leshnower
, Kreton Mavromatis
, Eric L Sarin
, Tom C Nguyen
, Mihir Kanitkar
, Robert A Guyton
, Peter C Block
, Amanda L Maas
, Amy Simone
, Patricia Keegan
, John Merlino
, James P Stewart
, Stamatios Lerakis
, Vasilis Babaliaros

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Patient characteristics and procedural outcomes from nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) in high-risk or inoperable patients with aortic stenosis have been incompletely reported. The purpose of this study was to compare outcomes with non-TF TAVR access techniques including transapical (TA), transaortic (TAo), and transcarotid (TC) TAVR with a balloon-expandable valve.

METHODS: A retrospective review was performed of all patients undergoing TA, TAo, and TC TAVR from 2007 to 2013 at Emory University. Preoperative risk factors and postoperative outcomes were evaluated using Valve Academic Research Consortium-2 definitions.

RESULTS: Of 469 patients undergoing TAVR during that period at our institution, 139 underwent TA TAVR, 35 had Tao TAVR, and 11 had TC TAVR. Patients undergoing TC TAVR were younger than those undergoing TA TAVR and TAo TAVR (mean ages: TC, 68.9 ± 23.6 years; TA, 81.3 ± 7.7 years; Tao, 83.8 ± 8.3 years; p = 0.017). Most patients undergoing TAo TAVR were women (82.9%), whereas patients undergoing TA TAVR were more likely to be men (62.6%). Slightly more than half of patients undergoing TA TAVR (54.7%) and TC (54.6%) TAVR had undergone previous coronary artery bypass grafting (CABG), whereas no patients underwent TAo TAVR (0%). There was no preoperative difference in ejection fraction, New York Heart Association classification, significant chronic obstructive pulmonary disease, and The Society of Thoracic Surgeons predicted risk of mortality between TA TAVR, Tao TAVR, and TC TAVR, respectively. Average postoperative length of stay was 9 to 11 days and was similar among groups (p = 0.22). There were 13 (9.4%) TA TAVR operative deaths and 4 (11.4%) operative deaths in the TAo TAVR group. There were no deaths in the TC TAVR group.

CONCLUSIONS: In high-risk and inoperable patients who are not candidates for TF TAVR, careful selection of alternative access options can lead to excellent and comparable postoperative outcomes.

Original language	English
Pages (from-to)	817-23; discussion 823-5
Journal	The Annals of thoracic surgery
Volume	99
Issue number	3
DOIs	https://doi.org/10.1016/j.athoracsur.2014.10.012
State	Published - Feb 2015
Externally published	Yes

Keywords

Aged
Aged, 80 and over
Aorta, Thoracic
Aortic Valve Stenosis/surgery
Carotid Artery, Common
Female
Humans
Male
Retrospective Studies
Risk Assessment
Transcatheter Aortic Valve Replacement/methods
Treatment Outcome

Access to Document

10.1016/j.athoracsur.2014.10.012

Cite this

Thourani, V. H., Li, C., Devireddy, C., Jensen, H. A., Kilgo, P., Leshnower, B. G., Mavromatis, K., Sarin, E. L., Nguyen, T. C., Kanitkar, M., Guyton, R. A., Block, P. C., Maas, A. L., Simone, A., Keegan, P., Merlino, J., Stewart, J. P., Lerakis, S., & Babaliaros, V. (2015). High-risk patients with inoperative aortic stenosis: use of transapical, transaortic, and transcarotid techniques. The Annals of thoracic surgery, 99(3), 817-23; discussion 823-5. https://doi.org/10.1016/j.athoracsur.2014.10.012

Thourani, VH, Li, C, Devireddy, C, Jensen, HA, Kilgo, P, Leshnower, BG, Mavromatis, K, Sarin, EL, Nguyen, TC, Kanitkar, M, Guyton, RA, Block, PC, Maas, AL, Simone, A, Keegan, P, Merlino, J, Stewart, JP, Lerakis, S & Babaliaros, V 2015, 'High-risk patients with inoperative aortic stenosis: use of transapical, transaortic, and transcarotid techniques', The Annals of thoracic surgery, vol. 99, no. 3, pp. 817-23; discussion 823-5. https://doi.org/10.1016/j.athoracsur.2014.10.012

@article{15c1b2ce2226454b87cb7192d42444e0,

title = "High-risk patients with inoperative aortic stenosis: use of transapical, transaortic, and transcarotid techniques",

abstract = "BACKGROUND: Patient characteristics and procedural outcomes from nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) in high-risk or inoperable patients with aortic stenosis have been incompletely reported. The purpose of this study was to compare outcomes with non-TF TAVR access techniques including transapical (TA), transaortic (TAo), and transcarotid (TC) TAVR with a balloon-expandable valve.METHODS: A retrospective review was performed of all patients undergoing TA, TAo, and TC TAVR from 2007 to 2013 at Emory University. Preoperative risk factors and postoperative outcomes were evaluated using Valve Academic Research Consortium-2 definitions.RESULTS: Of 469 patients undergoing TAVR during that period at our institution, 139 underwent TA TAVR, 35 had Tao TAVR, and 11 had TC TAVR. Patients undergoing TC TAVR were younger than those undergoing TA TAVR and TAo TAVR (mean ages: TC, 68.9 ± 23.6 years; TA, 81.3 ± 7.7 years; Tao, 83.8 ± 8.3 years; p = 0.017). Most patients undergoing TAo TAVR were women (82.9\%), whereas patients undergoing TA TAVR were more likely to be men (62.6\%). Slightly more than half of patients undergoing TA TAVR (54.7\%) and TC (54.6\%) TAVR had undergone previous coronary artery bypass grafting (CABG), whereas no patients underwent TAo TAVR (0\%). There was no preoperative difference in ejection fraction, New York Heart Association classification, significant chronic obstructive pulmonary disease, and The Society of Thoracic Surgeons predicted risk of mortality between TA TAVR, Tao TAVR, and TC TAVR, respectively. Average postoperative length of stay was 9 to 11 days and was similar among groups (p = 0.22). There were 13 (9.4\%) TA TAVR operative deaths and 4 (11.4\%) operative deaths in the TAo TAVR group. There were no deaths in the TC TAVR group.CONCLUSIONS: In high-risk and inoperable patients who are not candidates for TF TAVR, careful selection of alternative access options can lead to excellent and comparable postoperative outcomes.",

keywords = "Aged, Aged, 80 and over, Aorta, Thoracic, Aortic Valve Stenosis/surgery, Carotid Artery, Common, Female, Humans, Male, Retrospective Studies, Risk Assessment, Transcatheter Aortic Valve Replacement/methods, Treatment Outcome",

author = "Thourani, \{Vinod H\} and Chun Li and Chandan Devireddy and Jensen, \{Hanna A\} and Patrick Kilgo and Leshnower, \{Bradley G\} and Kreton Mavromatis and Sarin, \{Eric L\} and Nguyen, \{Tom C\} and Mihir Kanitkar and Guyton, \{Robert A\} and Block, \{Peter C\} and Maas, \{Amanda L\} and Amy Simone and Patricia Keegan and John Merlino and Stewart, \{James P\} and Stamatios Lerakis and Vasilis Babaliaros",

year = "2015",

month = feb,

doi = "10.1016/j.athoracsur.2014.10.012",

language = "English",

volume = "99",

pages = "817--23; discussion 823--5",

journal = "The Annals of thoracic surgery",

issn = "0003-4975",

number = "3",

}

TY - JOUR

T1 - High-risk patients with inoperative aortic stenosis

T2 - use of transapical, transaortic, and transcarotid techniques

AU - Thourani, Vinod H

AU - Li, Chun

AU - Devireddy, Chandan

AU - Jensen, Hanna A

AU - Kilgo, Patrick

AU - Leshnower, Bradley G

AU - Mavromatis, Kreton

AU - Sarin, Eric L

AU - Nguyen, Tom C

AU - Kanitkar, Mihir

AU - Guyton, Robert A

AU - Block, Peter C

AU - Maas, Amanda L

AU - Simone, Amy

AU - Keegan, Patricia

AU - Merlino, John

AU - Stewart, James P

AU - Lerakis, Stamatios

AU - Babaliaros, Vasilis

PY - 2015/2

Y1 - 2015/2

N2 - BACKGROUND: Patient characteristics and procedural outcomes from nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) in high-risk or inoperable patients with aortic stenosis have been incompletely reported. The purpose of this study was to compare outcomes with non-TF TAVR access techniques including transapical (TA), transaortic (TAo), and transcarotid (TC) TAVR with a balloon-expandable valve.METHODS: A retrospective review was performed of all patients undergoing TA, TAo, and TC TAVR from 2007 to 2013 at Emory University. Preoperative risk factors and postoperative outcomes were evaluated using Valve Academic Research Consortium-2 definitions.RESULTS: Of 469 patients undergoing TAVR during that period at our institution, 139 underwent TA TAVR, 35 had Tao TAVR, and 11 had TC TAVR. Patients undergoing TC TAVR were younger than those undergoing TA TAVR and TAo TAVR (mean ages: TC, 68.9 ± 23.6 years; TA, 81.3 ± 7.7 years; Tao, 83.8 ± 8.3 years; p = 0.017). Most patients undergoing TAo TAVR were women (82.9%), whereas patients undergoing TA TAVR were more likely to be men (62.6%). Slightly more than half of patients undergoing TA TAVR (54.7%) and TC (54.6%) TAVR had undergone previous coronary artery bypass grafting (CABG), whereas no patients underwent TAo TAVR (0%). There was no preoperative difference in ejection fraction, New York Heart Association classification, significant chronic obstructive pulmonary disease, and The Society of Thoracic Surgeons predicted risk of mortality between TA TAVR, Tao TAVR, and TC TAVR, respectively. Average postoperative length of stay was 9 to 11 days and was similar among groups (p = 0.22). There were 13 (9.4%) TA TAVR operative deaths and 4 (11.4%) operative deaths in the TAo TAVR group. There were no deaths in the TC TAVR group.CONCLUSIONS: In high-risk and inoperable patients who are not candidates for TF TAVR, careful selection of alternative access options can lead to excellent and comparable postoperative outcomes.

AB - BACKGROUND: Patient characteristics and procedural outcomes from nontransfemoral (non-TF) transcatheter aortic valve replacement (TAVR) in high-risk or inoperable patients with aortic stenosis have been incompletely reported. The purpose of this study was to compare outcomes with non-TF TAVR access techniques including transapical (TA), transaortic (TAo), and transcarotid (TC) TAVR with a balloon-expandable valve.METHODS: A retrospective review was performed of all patients undergoing TA, TAo, and TC TAVR from 2007 to 2013 at Emory University. Preoperative risk factors and postoperative outcomes were evaluated using Valve Academic Research Consortium-2 definitions.RESULTS: Of 469 patients undergoing TAVR during that period at our institution, 139 underwent TA TAVR, 35 had Tao TAVR, and 11 had TC TAVR. Patients undergoing TC TAVR were younger than those undergoing TA TAVR and TAo TAVR (mean ages: TC, 68.9 ± 23.6 years; TA, 81.3 ± 7.7 years; Tao, 83.8 ± 8.3 years; p = 0.017). Most patients undergoing TAo TAVR were women (82.9%), whereas patients undergoing TA TAVR were more likely to be men (62.6%). Slightly more than half of patients undergoing TA TAVR (54.7%) and TC (54.6%) TAVR had undergone previous coronary artery bypass grafting (CABG), whereas no patients underwent TAo TAVR (0%). There was no preoperative difference in ejection fraction, New York Heart Association classification, significant chronic obstructive pulmonary disease, and The Society of Thoracic Surgeons predicted risk of mortality between TA TAVR, Tao TAVR, and TC TAVR, respectively. Average postoperative length of stay was 9 to 11 days and was similar among groups (p = 0.22). There were 13 (9.4%) TA TAVR operative deaths and 4 (11.4%) operative deaths in the TAo TAVR group. There were no deaths in the TC TAVR group.CONCLUSIONS: In high-risk and inoperable patients who are not candidates for TF TAVR, careful selection of alternative access options can lead to excellent and comparable postoperative outcomes.

KW - Aged

KW - Aged, 80 and over

KW - Aorta, Thoracic

KW - Aortic Valve Stenosis/surgery

KW - Carotid Artery, Common

KW - Female

KW - Humans

KW - Male

KW - Retrospective Studies

KW - Risk Assessment

KW - Transcatheter Aortic Valve Replacement/methods

KW - Treatment Outcome

U2 - 10.1016/j.athoracsur.2014.10.012

DO - 10.1016/j.athoracsur.2014.10.012

M3 - Article

C2 - 25596868

SN - 0003-4975

VL - 99

SP - 817-23; discussion 823-5

JO - The Annals of thoracic surgery

JF - The Annals of thoracic surgery

IS - 3

ER -