1. Transcarotid Approach for Transcatheter Aortic Valve Replacement With the Sapien 3 Prosthesis
- Author
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Oliver Fouquet, Pavel Overtchouk, Mathieu Pernot, Christophe Caussin, Chekrallah Chamandi, Maxime Hubert, Thomas Gandet, Alexandre Azmoun, Vito G. Ruggieri, Thomas Modine, Majid Harmouche, Antoine Lafont, Said Ghostine, Jean-Philippe Verhoye, Joel Lapeze, Thierry Folliguet, Konstantinos Zannis, Alessandro Di Cesare, Frédéric Pinaud, Guillaume Bonnet, Florence Leclercq, Jean Philippe Claudel, Pole Cardio-vasculaire et pulmonaire [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de chirurgie thoracique et cardio-vasculaire [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Département de Chirurgie Vasculaire [Angers] (DCV - Angers), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Clinique de l'Infirmerie Protestante, Centre chirurgical Marie Lannelongue, Centre Chirurgical Marie Lannelongue (CCML), Institut Mutualiste de Montsouris (IMM), Centre Hospitalier Universitaire [Rennes], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital universitaire Robert Debré [Reims], Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and CCSD, Accord Elsevier
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medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,TAVR ,Prosthesis ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Interquartile range ,medicine ,MESH: Aortic Valve Stenosis/surgery ,Carotid Arteries ,Catheterization Peripheral/adverse effects ,Heart Valve Prosthesis ,030212 general & internal medicine ,Stroke ,Framingham Risk Score ,business.industry ,Gold standard ,Sapien 3 ,Perioperative ,medicine.disease ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,3. Good health ,Surgery ,Transcarotid ,Cohort ,Cardiology and Cardiovascular Medicine ,business - Abstract
International audience; Objectives: This study sought to describe the procedural and clinical outcomes of patients undergoing transcarotid (TC) transcatheter aortic valve replacement (TAVR) with the Edwards Sapien 3 device.Background: The TC approach for TAVR holds the potential to become the optimal alternative to the transfemoral gold standard. Limited data exist regarding safety and efficacy of TC-TAVR using the Edwards Sapien 3 device.Methods: The French Transcarotid TAVR prospective multicenter registry included patients between 2014 and 2018. Consecutive patients treated in 1 of the 13 participating centers ineligible for transfemoral TAVR were screened for TC-TAVR. Clinical and echocardiographic data were prospectively collected. Perioperative and 30-day outcomes were reported according to the updated Valve Academic Research Consortium (VARC-2).Results: A total of 314 patients were included with a median (interquartile range) age of 83 (78 to 88) years, 63% were males, Society of Thoracic Surgeons mortality risk score 5.8% (4% to 8.3%). Most patients presented with peripheral artery disease (64%). TC-TAVR was performed under general anesthesia in 91% of cases, mostly using the left carotid artery (73.6%) with a procedural success of 97%. Three annulus ruptures were reported, all resulting in patient death. At 30 days, rates of major bleeding, new permanent pacemaker, and stroke or transient ischemic attack were 4.1%, 16%, and 1.6%, respectively. The 30-day mortality was 3.2%.Conclusions: TC-TAVR using the Edwards Sapien 3 device was safe and effective in this prospective multicenter registry. The TC approach might be considered, in selected patients, as the first-line alternative approach for TAVR whenever the transfemoral access is prohibited. Sapien 3 device was safe and effective in our multicenter cohort.
- Published
- 2019
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