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Thorac Cardiovasc Surg 2022; 70(03): 189-198
DOI: 10.1055/s-0041-1727131
Original Cardiovascular

Transcatheter Aortic Valve Implantation in Patients Who Cannot Undergo Transfemoral Access

Dritan Useini 
1   Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
,
Blerta Beluli
2   Department of Internal Medicine, St. Anna Hospital, Herne, Germany
,
Hildegard Christ
3   Department of Medical Statistics, Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Germany
,
Markus Schlömicher
1   Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
,
Polykarpos Patsalis
4   Department of Cardiology and Angiology, Ruhr University Hospital Bergmannsheil, Bochum, Germany
,
Peter Haldenwang
1   Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
,
Justus Strauch
1   Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
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Abstract

Introduction Though transfemoral (TF) access has emerged as a gold standard access for patients with aortic stenosis who undergo transcatheter aortic valve implantation (TAVI), there has been no study that has characterized patients who cannot undergo TF access in detail. We aim to evaluate the contraindications for TF access, their incidence, classify them, and provide the outcomes of patients who failed to be TF candidates.

Methods From 925 patients who underwent TAVI between February 2014 and May 2020 at our heart center, 130 patients failed to be TF candidates and underwent transapical-transcatheter aortic valve implantation (TA-TAVI). In this study, we included all those patients who failed to be TF candidates and underwent TA-TAVI using the third-generation balloon expandable valve (Edwards SAPIEN 3 valve [S3]) (116 patients; STS score 6.07 ± 4.4; age 79.4 ± 7).

Results The incidence of patients unsuitable for TF access at our heart center was 14%. We classified this TAVI population into absolute contraindication for TF access n = 84 (72.5%) and increased interventional risk for TF access n = 32 (27.5%). After TA-TAVI of this specific population using S3, the in-hospital mortality and stroke were 1.7 and 1.7%, respectively. The vascular injury rate was 1.7%. We registered no paravalvular leakage ≥2. The pacemaker rate was 7.4%. The mean transvalvular pressure gradient was 8.7 mm Hg.

Conclusion The incidence of patients who cannot undergo TF access or who are at high interventional risk is considerably high. TA-TAVI, supported with sufficient interventional experience and appropriate valve system, represents an excellent alternative for patients with distinct vasculopathy.

Keywords

heart center - transapical - TF-TAVI - COPD - peripheral vascular disease - aorta

Authors' Contributions

D.U. contributed to the conception, design, data collection, acquisition, analysis, interpretation of data, drafting, and revising of the work. B.B. contributed to the conception, design, and revising of the work. H.C. contributed to the statistics, analysis, and interpretation of data and revision. M.S., P.P., and P.H. contributed to data collection and revision. J.S. contributed substantially to the design and intellectual revision of the work. All authors approve this final version for publication and agree to be accountable for all aspects of this work.




Publikationsverlauf

Eingereicht: 23. Dezember 2020

Angenommen: 12. Februar 2021

Artikel online veröffentlicht:
13. April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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