Details

Autor(en) / Beteiligte

• Okuyama, Kazuaki, MD
• Jilaihawi, Hasan, MD
• Mirocha, James, MS
• Nakamura, Mamoo, MD
• Ramzy, Danny, MD, PhD
• Makkar, Raj, MD
• Cheng, Wen, MD

Titel

Alternative access for balloon-expandable transcatheter aortic valve replacement: Comparison of the transaortic approach using right anterior thoracotomy to partial J-sternotomy

Ist Teil von

• The Journal of thoracic and cardiovascular surgery, 2015-03, Vol.149 (3), p.789-797

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• Objectives For transcatheter aortic valve replacement (TAVR), transaortic (TAo) and transapical (TA) approaches are major alternatives in cases unsuitable for the transfemoral approach. Partial J-sternotomy is a widely used access for TAo. However, redo sternotomy or right-sided aorta may preclude this access, and right anterior thoracotomy is potentially beneficial in these cases. This study sought to evaluate the TAo approach using thoracotomy (T-TAo) and compare it to the TAo approach using a sternotomy (S-TAo) and a TA approach. Methods In a large single-center series, consecutive TAVR patients were studied. Procedural/clinical outcomes of the T-TAo, S-TAo, and TA groups were compared up to a 30 days follow-up period. Results Of 872 TAVR patients, 22 (2.5%) were T-TAo, 29 (3.3%) were S-TAo, and 86 (9.9%) were TA approaches. The TA group showed the shortest intensive care unit stay, with a median 2.0 (interquartile range 1.0-3.0) days: for T-TAo it was 3.0 (2.0-5.3) and for S-TAo, 3.0 (3.5-5.0) ( P  < .001). Although it was not statistically significant, the T-TAo group showed numerically less mortality (1 [4.5%], 5 [17.9%], and 8 [9.4%] in the T-TAo, S-TAo, and TA groups, respectively; P  = .30), with no difference in other endpoints, including stroke/transient ischemic attack, rehospitalization, and paravalvular leak. Additionally, computed tomographic assessment revealed that T-TAo facilitated a more coaxial approach than S-TAo: 20.4° ± 8.2° versus 30.6° ± 8.2° ( P  < .001). Conclusions T-TAo is a feasible approach that can provide greater coaxiality. This option allows tailored and optimal access to the individual patient and facilitates a treatment strategy in nontransfemoral TAVR patients.