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Article Dans Une Revue JACC: Cardiovascular Interventions Année : 2016

Transcatheter Aortic Valve Replacement Using Transaortic Access

Vinayak Bapat
  • Fonction : Auteur
Derk Frank
  • Fonction : Auteur
Ricardo Cocchieri
  • Fonction : Auteur
Dariusz Jagielak
  • Fonction : Auteur
Nikolaos Bonaros
  • Fonction : Auteur
Marco Aiello
  • Fonction : Auteur
Joel Lapeze
  • Fonction : Auteur
Mika Laine
  • Fonction : Auteur
Douglas Muir
  • Fonction : Auteur
Walter Eichinger
  • Fonction : Auteur
Matthias Thielmann
  • Fonction : Auteur
Kjell Arne Rein
  • Fonction : Auteur
Gino Gerosa
  • Fonction : Auteur
Hardy Baumbach
  • Fonction : Auteur
Peter Bramlage
  • Fonction : Auteur
Cornelia Deutsch
  • Fonction : Auteur
Martin Thoenes
  • Fonction : Auteur
Mauro Romano
  • Fonction : Auteur

Résumé

OBJECTIVES The Registry of the Utilization of the TAo-TAVR approach using the Edwards SAPIEN Valve (ROUTE) was established to assess the effectiveness and safety of the use of transaortic (TAo) access for transcatheter aortic valve replacement (TAVR) procedures (NCT01991431). BACKGROUND TAVR represents an alternative to surgical valve replacement in high-risk patients. Whereas the transfemoral access route is used commonly as the first-line approach, transapical access is an option for patients not suitable for transfemoral treatment mainly due to anatomic conditions. TAo-TAVR has been shown to be a viable alternative surgical access route; however, only limited data on its effectiveness and safety has been published. METHODS ROUTE is a multicenter, international, prospective, observational registry; data were collected from 18 centers across Europe starting in February 2013. Patients having severe calcific aortic stenosis were documented if they were scheduled to undergo TAo-TAVR using an Edwards SAPIEN XT or a SAPIEN 3 valve. The primary endpoint was 30-day mortality. Secondary endpoints were intraprocedural or in hospital and 30-day complication rates. RESULTS A total of 301 patients with a mean age of 81.7 +/- 5.9 years and an Society of Thoracic Surgeons score of 9.0 +/- 7.6% were included. Valve success was documented in 96.7%. The 30-day mortality was 6.1% (18/293) (procedure-related mortality: 3.1%; 9 of 293). The Valve Academic Research Consortium-2 defined complications included myocardial infarction (1.0%), stroke (1.0%), transient ischemic attack (0.3%), major vascular complications (3.4%), life-threatening bleeding (3.4%), and acute kidney injury (9.5%). In 3.3% of patients, paravalvular regurgitation was classified as moderate or severe (10 of 300). Twenty-six patients (8.8%) required permanent pacemaker implantation. CONCLUSIONS TAo access for TAVR seems to be a safe alternative to the transapical procedure. (C) 2016 by the American College of Cardiology Foundation.

Dates et versions

hal-01414465 , version 1 (12-12-2016)

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Vinayak Bapat, Derk Frank, Ricardo Cocchieri, Dariusz Jagielak, Nikolaos Bonaros, et al.. Transcatheter Aortic Valve Replacement Using Transaortic Access. JACC: Cardiovascular Interventions, 2016, 9 (17), pp.1815--1822. ⟨10.1016/j.jcin.2016.06.031⟩. ⟨hal-01414465⟩
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