Author + information
- Vikas Singh,
- Mauricio Cohen,
- Claudia Martinez,
- Brian O'Neill,
- Carlos Alfonso,
- Pedro Martinez Clark,
- Alan Heldman and
- William O'Neill
Transcatheter aortic valve replacement (TAVR) was first done via the transseptal (TS) approach, but this was largely abandoned in favor of retrograde transfemoral (TF), transaortic (TAo) or transapical (TA) approaches. TS TAVR may still be warranted in patients for whom no other approach is feasible.
Observational consecutive case series at a single center, to evaluate technical outcomes in inoperable patients with aortic stenosis (AS) who had contraindications for TF, TA or TAo access and who underwent TAVR via a transvenous TS antegrade approach using the Edwards–Sapien (ES) valve.
Over a 4–month period, 9 patients (5 men and 4 women) underwent TS TAVR with 26mm (n=4) and 23mm (n=5) ES valves. Mean age was 84.5±6.6 years and Society of Thoracic Surgeons predicted risk of mortality was 7.8 ± 2.8%. Specific contraindications for TF, TA or TAo access included iliofemoral arterial diameter < 7mm in 9 (100%), porcelain aorta in 6 (66%) patients, multiple (≥2) sternotomies in 2 (22%) patients, severe pulmonary disease in 3 (33%), extreme frailty in 1 (11%), spinal stenosis with impaired ability to rehabilitate post–surgery in 1 (11%) and apical left ventricular thrombus in 1 (11%) patient. Additional comorbidities included coronary artery disease (n=8), peripheral arterial disease (n=7) and cerebrovascular disease (n=9). Antegrade deployment of the valve was technically feasible in 8 patients (89%). No patient had hemodynamically significant post–TAVR aortic insufficiency nor damage to the mitral valve. Vascular complications occurred in 2 patients; 1 patient suffered transient complete heart block and hemodynamic collapse requiring pacing and balloon counterpulsation; two patients suffered acute kidney injury. Median (25th, 75th) length of ICU stay was 3 (2, 3) days and length of hospital stay was 5 (5, 11) days. At 6 months follow–up, there were 2 deaths, no cerebrovascular events or rehospitalizations and mean NYHA Class improved from 3.4 to 1.7.
The antegrade TS approach to TAVR is a technically feasible option for “no–access” patients. Prospective assessment of the safety and efficacy of this approach in the current era warrants further study.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2114–240
- 2013 American College of Cardiology Foundation