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. 2020 Aug;96(2):459-470.
doi: 10.1002/ccd.28697. Epub 2020 Jan 11.

A less-invasive totally-endovascular (LITE) technique for trans-femoral transcatheter aortic valve replacement

Francesco Burzotta  1 , Cristina Aurigemma  1 , Enrico Romagnoli  1 , Osama Shoeib  2 , Giulio Russo  1 , Aniello Zambrano  1 , Diana Verdirosi  1 , Antonio Maria Leone  1 , Piergiorgio Bruno  1 , Carlo Trani  1
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A less-invasive totally-endovascular (LITE) technique for trans-femoral transcatheter aortic valve replacement

Francesco Burzotta et al. Catheter Cardiovasc Interv. 2020 Aug.

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.

Keywords: endovascular interventions; personalized medicine; temporary pace-maker; trans-femoral approach; trans-radial approach; transcatheter-aortic-valve-replacement.

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References

REFERENCES

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