Original articleAdult cardiacTransapical Aortic Valve Implantation Without Angiography: Proof of Concept
Section snippets
Material and Methods
Between November 2008 and November 2009, 14 men and 16 females suffering from severe aortic valve stenosis underwent 30 consecutive TA-TAVI using 23 mm/26 mm Sapien stent-valves and Ascendra systems (Edwards Lifesciences, Irvine, CA).
All patients were extensively informed about the modified minimally invasive procedure and they all signed an informed consent following the guidelines of our internal ethical committee. All cases were performed under general anesthesia in the operating theater
Results
Preoperative patient characteristics are listed in Table 1. Thirty consecutive patients suffering from aortic stenosis underwent TA-TAVI in our center: the mean age and the calculated logistic EuroSCORE were 80.1 ± 8.7 years and 32.2 ± 13.3%, respectively. Additional comorbidities, not included in the EuroSCORE, were severe liver cirrhosis (2 patients), calcified ascending aorta (2 patients), and previous radiotherapy for mediastinal and breast cancer (2 patients). All patients underwent a
Comment
We recently introduced the TA-TAVI without angiography in our routine practice in order to prevent postoperative renal failure in high-risk patients requiring minimally invasive aortic valve surgery. In fact, it is well known that the extensive use of contrast medium in the elderly with multiple concomitant comorbidities can induce nephrotoxicity with subsequent renal insufficiency and (sometimes) need for transitory dialysis: such a scenario can cause prolonged hospital recoveries and negative
References (20)
- et al.
Transapical aortic valve implantation: step by step
Ann Thorac Surg
(2009) - et al.
Routine use of intravascular ultrasound for endovascular aneurysm repair: angiography is not necessary
Eur J Vasc Endovasc Surg
(2002) - et al.
Mortality associated with nephropathy after radiographic contrast exposure
Mayo Clin Proc
(2008) - et al.
Predictors for contrast media-induced nephropathy and long-term survival: prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial
Can J Cardiol
(2008) Contrast-induced acute kidney injury
J Am Coll Cardiol
(2008)- et al.
Serious renal dysfunction after percutaneous coronary interventions can be predicted
Am Heart J
(2008) - et al.
The transapical approach for aortic valve implantation
J Thorac Cardiovasc Surg
(2008) - et al.
Transapical transcatheter aortic valve implantation: 1-year outcome in 26 patients
J Thorac Cardiovasc Surg
(2009) - et al.
Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)
Eur J Cardiothorac Surg
(2008) - et al.
Minimally invasive transapical beating heart aortic valve implantation - proof of concept
Eur J Cardiothorac Surg
(2007)
Cited by (32)
Echocardiographic Imaging for Transcatheter Aortic Valve Replacement
2018, Journal of the American Society of EchocardiographyCitation Excerpt :The benefits of this new approach have included lower use of intensive care units, shorter length of stay, and lower cost. This must be weighed against the reports of possible higher paravalvular regurgitation rates,169,170 nephrotoxic contrast agent use,171,172 and the increased morbidity of conversion to GA with CS and TEE.173 Some centers have continued to use GA and TEE but with a “fast track” algorithm that has shortened length of intensive care unit and hospital stays, as well as reduced cost.174
Phantom study of an ultrasound guidance system for transcatheter aortic valve implantation
2016, Computerized Medical Imaging and GraphicsCitation Excerpt :TEE is frequently used during TAVI procedures for assessing valve function after the stent is deployed. Intraoperative guidance using only TEE [12] and TEE with fluoroscopy (without contrast agents) [13] has been previously reported. However, TEE does not provide satisfactory imaging of the catheter or surrounding tissue due to the highly reflective surface of the catheter and resulting shadowing artifacts.
Transapical Versus Transaortic Transcatheter Aortic Valve Implantation: A Systematic Review
2015, Annals of Thoracic SurgeryIntracardiac echocardiography: A new guiding tool for transcatheter aortic valve replacement
2011, Journal of the American Society of EchocardiographyCitation Excerpt :Although not addressed in this study, sparing use of contrast agent is meaningful, because renal failure has been reported to be the most common short-term complication after TAVR.24 Echocardiography was recently shown to be capable of lowering the amount of contrast agent used during TAVR procedures.25 However, further investigations are needed to test ICE in that respect.
Cardiac CT: Practical approach to integrate appropriate indications in daily practice
2011, Presse MedicaleCitation Excerpt :Both approaches require morphologic evaluation of the ascending aorta, coronary arteries, aortic annulus and left ventricle out-flow tract [27,31] (figure 6). In more sophisticated approach, angulations of the aortic valve plane could be given to optimize the view for the valve implantation [30,32]. For the transfemoral access, CCT should be combined to CT angiography of the abdominal aorta and pelvic arteries to complete information needed for using pelvic (minimal diameter of arteries, angulations and degree of calcifications).
Successful combined minimally invasive direct coronary artery bypass and transapical aortic valve implantation
2011, Annals of Thoracic Surgery