Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience
Background: Trans-femoral (TF) represents the main access for TAVI. Although there are various technical strategies to conduct TF-TAVI (pacing modality, secondary arterial access, primary access puncture etc.), the optimal technique is not recognized. Aims: In the present study, we assessed the impa...
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Elsevier
2024-12-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906724001891 |
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| author | Enrico Romagnoli Francesco Bianchini Cristina Aurigemma Andrea Zito Emiliano Bianchini Lazzaro Paraggio Mattia Lunardi Carolina Ierardi Marialisa Nesta Piergiorgio Bruno Francesco Burzotta Carlo Trani |
| author_facet | Enrico Romagnoli Francesco Bianchini Cristina Aurigemma Andrea Zito Emiliano Bianchini Lazzaro Paraggio Mattia Lunardi Carolina Ierardi Marialisa Nesta Piergiorgio Bruno Francesco Burzotta Carlo Trani |
| author_sort | Enrico Romagnoli |
| collection | DOAJ |
| description | Background: Trans-femoral (TF) represents the main access for TAVI. Although there are various technical strategies to conduct TF-TAVI (pacing modality, secondary arterial access, primary access puncture etc.), the optimal technique is not recognized. Aims: In the present study, we assessed the impact of systematic use of LITE-TAVI in terms of feasibility, safety, and main access complication management using VARC-3 outcomes definitions. Methods: At our institution, a less-invasive totally-endovascular (LITE) technique for TF-TAVI has been developed since 2017. Key aspects are: precise TAVI access puncture using angiographic-guidewire ultrasound guidance; radial/ulnar approach as the default “secondary access”; non-invasive pacing (by guidewire stimulation or definitive pacemaker external programmer). Results: 1022 consecutive TF-TAVI patients (55 % women, mean age: 80 years, mean EuroSCORE II 6.1 %, mean STS-PROM 4.3 %, mean STS/ACC TVT TAVR mortality score 3.4 %) were approached using the LITE technique. Technical success was achieved in 993 (97.2 %) patients. Access-related major vascular complications occurred in 12 (1.2 %) and VARC-3 ≥ type 2 bleedings in 12 (1.2 %) patients. At 30-day, all-cause death occurred in 17 (1.7 %) patients. This figure resulted significantly lower than expected on the bases of the mortality predicted not only by EuroSCORE II (6.1 %, p < 0.001) and STS-PROM score (4.3 %; p < 0.001), but also by STS/ACC TVT TAVR mortality score (3.4 %; p = 0.01). Conclusions: Systematic use of LITE-TAVI is feasible and is associated with an extremely low rate of access-related bleeding and vascular complications which may drive to outcome improvement. |
| format | Article |
| id | doaj-art-b8aae197fc7e4537b711df52e47e0620 |
| institution | Kabale University |
| issn | 2352-9067 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-b8aae197fc7e4537b711df52e47e06202024-11-29T06:24:22ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672024-12-0155101523Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experienceEnrico Romagnoli0Francesco Bianchini1Cristina Aurigemma2Andrea Zito3Emiliano Bianchini4Lazzaro Paraggio5Mattia Lunardi6Carolina Ierardi7Marialisa Nesta8Piergiorgio Bruno9Francesco Burzotta10Carlo Trani11Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, ItalyDepartment of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Corresponding author at: at: Università Cattolica del Sacro Cuore, Rome, Italy.Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, ItalyBackground: Trans-femoral (TF) represents the main access for TAVI. Although there are various technical strategies to conduct TF-TAVI (pacing modality, secondary arterial access, primary access puncture etc.), the optimal technique is not recognized. Aims: In the present study, we assessed the impact of systematic use of LITE-TAVI in terms of feasibility, safety, and main access complication management using VARC-3 outcomes definitions. Methods: At our institution, a less-invasive totally-endovascular (LITE) technique for TF-TAVI has been developed since 2017. Key aspects are: precise TAVI access puncture using angiographic-guidewire ultrasound guidance; radial/ulnar approach as the default “secondary access”; non-invasive pacing (by guidewire stimulation or definitive pacemaker external programmer). Results: 1022 consecutive TF-TAVI patients (55 % women, mean age: 80 years, mean EuroSCORE II 6.1 %, mean STS-PROM 4.3 %, mean STS/ACC TVT TAVR mortality score 3.4 %) were approached using the LITE technique. Technical success was achieved in 993 (97.2 %) patients. Access-related major vascular complications occurred in 12 (1.2 %) and VARC-3 ≥ type 2 bleedings in 12 (1.2 %) patients. At 30-day, all-cause death occurred in 17 (1.7 %) patients. This figure resulted significantly lower than expected on the bases of the mortality predicted not only by EuroSCORE II (6.1 %, p < 0.001) and STS-PROM score (4.3 %; p < 0.001), but also by STS/ACC TVT TAVR mortality score (3.4 %; p = 0.01). Conclusions: Systematic use of LITE-TAVI is feasible and is associated with an extremely low rate of access-related bleeding and vascular complications which may drive to outcome improvement.http://www.sciencedirect.com/science/article/pii/S2352906724001891Transcatheter aortic valve implantationPersonalized medicine, endovascular interventionsTemporary pacemakerTrans-femoral approachTrans-radial approach |
| spellingShingle | Enrico Romagnoli Francesco Bianchini Cristina Aurigemma Andrea Zito Emiliano Bianchini Lazzaro Paraggio Mattia Lunardi Carolina Ierardi Marialisa Nesta Piergiorgio Bruno Francesco Burzotta Carlo Trani Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience International Journal of Cardiology: Heart & Vasculature Transcatheter aortic valve implantation Personalized medicine, endovascular interventions Temporary pacemaker Trans-femoral approach Trans-radial approach |
| title | Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience |
| title_full | Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience |
| title_fullStr | Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience |
| title_full_unstemmed | Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience |
| title_short | Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience |
| title_sort | feasibility safety and clinical impact of a less invasive totally endovascular lite technique for transfemoral tavi a 1000 patients single centre experience |
| topic | Transcatheter aortic valve implantation Personalized medicine, endovascular interventions Temporary pacemaker Trans-femoral approach Trans-radial approach |
| url | http://www.sciencedirect.com/science/article/pii/S2352906724001891 |
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