Transcatheter Aortic Valve And Coronary Intervention

Background:Patients who have aortic stenosis (AS) with severe heart failure or cardiogenic shock are considered unsuitable for surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), and generally have a poor prognosis with conservative therapy. It has been shown that percutaneous balloon aortic valvuloplasty (PBAV) may transiently improve severe left ventricular dysfunction in patients with AS.Objectives:To assess procedural and clinical outcomes in patients with severe AS undergoing PBAV, who are considered transiently unsuitable for either AVR or TAVI.Methods:Between March2011and January2013, a total of10patients underwent PBAV. Pre-and post-procedure aortic valve gradients were measured by catheterization and echocardiography. Patients were assessed for symptomatic benefit and clinical outcomes.Results:Mean patients age was70±8years (52-87),6were male, and the logistic EuroScore was26.1±6.7%.All patients were severe heart failure with New York Heart Association (NYHA) class>III, and5were in cardiogenic shock requiring inotropic support.Mean left ventricular fraction (LVEF) were29±6%, and LVEF≤30%was in6patients. PBAV was successfully performed in all cases. Mean transaortic valve gradient fell from50±18mmHg to33±14mmHg (P=0.028). The most common complications were hypotension and minor bleeding at the femoral puncture site.No patients died. during procedure, and2died in hospital:one died of pulmonary infection3days after procedure;1died of repeated ventricular tachycardia.Three died post-discharge:1died of cardiogenci shock at6-month;1had a sudden death at home at16-month;1died of multiple organ failure at5-month. Five patients underwent secondary successful TAVI (n=2)or AVR(n=3).Conclusions:In high-risk patients with AS and temporary contraindications to AVR or TAVI, PBAV can be safely used as a bridge to intervention with good outcomes. Background Transcatheter aortic valve implantation (TAVI)has emerged as a viable therapeutic option for patients with severe symptomatic aortic stenosis who are ineligible or at high-surgical-risk for conventional surgical aortic valve replacement.One randomized, controlled trial and some registry study have showed its feasible, safety and efficiency. However, TAVI is still in the exploratory stage in China.Objectives This study was to evaluate the early safety and efficacy of TAVI using domestic Venous Medtch bioprosthesis in high-surgical-risk patients with severe aortic stenosis.Methods Acardiac interventionalist and2experienced cardiothoracic surgeons agree that medical factors either preclude operation or are high risk for surgical AVR, based on a conclusion that the probability of death or serious, irreversible morbidity exceeds the probability of meaningful improvement. Preprocedural assessment includes heart function, aortic annular size and shape, distance between annulus and coronary ostia, aortic valve, dimensions and atherosclerosis of aorta and iliofemoral vessels using multidetector computed tomography (MDCT),transthoracic echocardiography (TTE), and transesophageal echocardiography (TEE). Postprocedural assessment includes degree of aortic regrugation using TTE, and cerebral embolization using cardiac magnetic resonance (CMR).Results Between December2010and January2013,85AS patients diagnosed by TTE underwent clinical screening, and12of which were performed TAVI. The primary endpoint was all cause mortality at1,6,12months. The mean age of the12patients was78±6years and5were female. Mean logistic EuroScore was24.8±8.5%. Procedural success and intraprocedural mortality were100%and0, respectively. The approaches use were transaortic (n=3) or transfemoral (n=9). In-hospital,1-and6-month mortality were0. Complications included femoral rupture needing balloon angioplasty in1patients, mild access site bleeding in4patients, and severe atrioventricular block needing permanent pacemaker implantation in2patients. Aortic regurgitation2+was observed in1patients, and all were≤1+at1month follow-up.ConclusionsThis registry reflects the real-life experience of transcatheter aortic valve implantation in high-risk elderly patients in China. The early results were satisfactory in terms of feasibility, short-term haemodynamic and functional improvement, and safety. Longer term follow-up will be further assessed. Background Transradial coronary intervention is a safe and effective method of percutaneous revascularization. Furthermore, the indications for transradial percutaneous coronary intervention (PCI) are expanding. However, the efficacy and the safety between TR and TF approaches of PCI for chronic total occlusion (CTO) have not been compared.Objectives This study sought to compare outcomes between transradial (TR) and transfemoral (TF) percutaneous revascularization in patients with chronic total occlusion (CTO).Methods Among2352consecutive patients with CTO disease treated with percutaneous revascularization by either TR (n=1858) or TF (n=494) vascular access, procedural outcomes, resource use, in-hospital bleeding, and late clinical events were compared according to vascular access method.Results Clinical and angiographic characteristic were similar in both groups.Duration of hospital stay(7.7±4.9vs.9.4±5.4, P<0.001) and in-hospital occurrence of bleeding defined by Bleeding Academic Research Consortium(5.9%vs.1.9%, P>0.001) were significantly lower with TR access. Using propensity score modeling (421matched pairs), over a mean follow-up period of15months, rates of death (0.5%vs.1.0%, P=0.413), nonfatal myocardial infarction (0.5%vs.0.5%, P=1.000), stent thrombosis (0.5%vs.0.5%, P=1.000), and any target vessel revascularization(4.0%vs.5.7%, P=0.262) did not statistically differ among TR and TR groups, reapectively.Conclusions In contrast to TF vascular access, TR percutaneous coronary revascularization for CTO disease is feasible and associated with similar procedural success, abbreviated hospitalization, reduced bleeding, and comparable late-term clinical safety and efficacy.