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A less‐invasive totally‐endovascular (LITE) technique for trans‐femoral transcatheter aortic valve replacement
Author(s) -
Burzotta Francesco,
Aurigemma Cristina,
Romagnoli Enrico,
Shoeib Osama,
Russo Giulio,
Zambrano Aniello,
Verdirosi Diana,
Leone Antonio Maria,
Bruno Piergiorgio,
Trani Carlo
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28697
Subject(s) - medicine , valve replacement , femoral artery , surgery , hemostasis , cardiology , radiology , stenosis
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.