A less‐invasive totally‐endovascular (LITE) technique for trans‐femoral transcatheter aortic valve replacement. Issue 2 (11th January 2020)

• Record Type: Journal Article
• Authors: Burzotta, Francesco; Aurigemma, Cristina; Romagnoli, Enrico; Shoeib, Osama; Russo, Giulio; Zambrano, Aniello; Verdirosi, Diana; Leone, Antonio Maria; Bruno, Piergiorgio; Trani, Carlo
• Is Part Of: Catheterization and cardiovascular interventions. Volume 96:Issue 2(2020)
• Page Start: 459
• Page End: 470
• Publication Date: 2020-01-11
• Subjects: endovascular interventions -- personalized medicine -- temporary pace‐maker -- transcatheter‐aortic‐valve‐replacement -- trans‐femoral approach -- trans‐radial approach; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.28697
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: To describe and report the results of an original technique for trans‐femoral (TF) transcatheter‐aortic‐valve‐replacement (TAVR). Background: TF approach represents the commonest TAVR technique. The best technique for TF‐TAVR is not recognized. Methods: We developed a less‐invasive totally‐endovascular (LITE) technique for TF‐TAVR. The key aspects are: precise TAVR access puncture using angiographic‐guidewire‐ultrasound guidance radial approach as the "secondary access" (to guide valve positioning, to check femoral‐access hemostasis and to manage eventual access‐site complications) non‐invasive pacing (by retrograde left ventricle stimulation or by definitive pace‐maker external programmer) The LITE technique has been systematically adopted at our Institution. Procedure details, complications and clinical events occurring during hospitalization were prospectively recorded. Major vascular complications and life‐threatening or major bleedings were the primary study end‐points. Results: A total of 153 consecutive patients referred for TF‐TAVR were approached using the LITE technique. Mean predicted surgical operative mortality was 4.9% and mean TAVR predicted mortality was 3.9%. In 132 (86.3%) patients, TAVR was completed without the need for additional femoral artery access or transvenous temporary pace‐maker implantation. Major vascular complications occurred in 2 (1.3%), life‐threatening or major bleedings occurred in 4 (2.6%) patients. All‐cause death occurred in 3 patients (2.0%). Conclusions: TF‐TAVR according to LITE technique is feasible and is associated with very low rates of vascular or bleeding complications.