Key result
The use of internal endoconduits in patients with unfavorable iliac artery anatomy eliminated the need for non-transfemoral TAVR approaches compared to a historical cohort (0% vs 11.4%, p=0.024).
Why the study?
Does the use of internal endoconduits reduce the need for non-transfemoral approaches in high-risk patients with severe aortic stenosis and unfavorable iliac artery anatomy undergoing TAVR?
Cohort (n=113)
No
Does the use of internal endoconduits reduce the need for non-transfemoral approaches in high-risk patients with severe aortic stenosis and unfavorable iliac artery anatomy undergoing TAVR?
Absolute Event Rate: 0% vs 11.4%
p-value: p=0.024
The use of internal endoconduits during TAVR in patients with unfavorable iliac anatomy significantly reduces the need for alternative non-transfemoral access routes.
May expand transfemoral TAVR options in complex iliac anatomy; leaves open safety, durability, and need for prospective trials.
BACKGROUND: Transfemoral (TF) access is associated with lower rates of surgical conversion and mortality compared with non-TF access for transcatheter aortic valve replacement (TAVR). Therefore, efforts should be made to make this procedure even less invasive, allowing more TAVR procedures to be performed through femoral access. We herein describe our single-center experience of using one-stage percutaneous internal endoconduits for TAVR in patients with unfavorable iliac artery anatomy. METHODS: Between March 2013 andMarch 2016, 113 consecutive patients with severe aortic stenosis at high risk for conventional cardiac surgery underwent TAVR at the Cheng Hsin General Hospital. The patients can be divided into Cohort A (March 2013-December 2014) and Cohort B (January 2015-March 2016). RESULTS: In the Cohort A, 6 out of the 53 (11.4%) with unfavorable iliac artery anatomy were treated by trans-subclavian approach (n = 3, 5.7%) or direct aortic approach (n = 3, 5.7%); while in the Cohort B, none (0%) of the 5 patients with unfavorable iliac artery anatomy among 60 consecutive TAVR cases needed non-TF approach (Cohort A vs. Cohort B = 11.4% vs. 0%, p = 0.024) and they were all successfully treated with the use of an internal endoconduit. CONCLUSIONS: The use of internal endoconduits can further increase the number of patients who can be treated through femoral artery access for TAVR and substantially reduce the need of non-TF approaches.
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Lee et al. (2018) conducted a cohort in Severe aortic stenosis at high risk for conventional cardiac surgery (n=113). Internal endoconduit vs. Historical cohort (no internal endoconduit) was evaluated on Need for non-transfemoral (non-TF) approach (p=0.024). The use of internal endoconduits in patients with unfavorable iliac artery anatomy eliminated the need for non-transfemoral TAVR approaches compared to a historical cohort (0% vs 11.4%, p=0.024).
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