A one-stop comparative study of CTA scan delay protocol for TAVI/TAVR patients / 西安交通大学学报(医学版)

Objective To compare the effect of preoperative CTA examination using group injection test and group injection tracking delay protocol on image quality in patients with transcatheter aortic valve implantation(TAVI)/transcatheter aortic valve replacement(TAVR).Methods A total of 43 patients who underwent TAVI/TAVR preoperative one-stop CTA examination in our hospital were randomly divided into two groups,and preoperative CTA examination was performed using group injection tracking and group injection test.After the scanning was completed,the aortic root sinus(C1),the proximal left and right coronary arteries(C2,C3),the ascending aorta(A1),the abdominal aorta(A2),the left and right femoral arteries(A3,A4),and the CT value and SD value of the paraspinal muscles of the same layer were measured;the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the corresponding parts were calculated.The obtained data results were compared and analyzed from both subjective and objective aspects.Results There was no significant difference in image quality between the two groups in the aortic root sinus(C1),the proximal left and right coronary arteries(C2,C3),or the ascending aorta(A1)(P＞0.05).At the renal artery level,there was a significant difference in image quality between the abdominal aorta(A2)and the left and right femoral artery levels(A3,A4)(P＜0.05).Conclusion In the preoperative one-stop CTA examination of TAVI/TAVR patients,the CTA images below the renal artery level can obtain better image quality than the group injection tracking method.

Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease: A Single-Center Experience

ABSTRACT Introduction: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease. Methods: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint. Results: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found. Conclusion: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.

Impacto de un Heart Team en pacientes con estenosis aórtica candidatos a reemplazo percutáneo / Impact of a Heart Team in patients with aortic stenosis who are candidates for transcatheter aortic valve replacement

RESUMEN La difusión del reemplazo valvular aórtico percutáneo (TAVI) en la estenosis aórtica (EAo) generó la creación de un Heart Team (HT), para elegir el mejor tratamiento. Existen pocos reportes sobre su utilidad. Objetivos: analizar los resultados del tratamiento de los pacientes con EAo evaluados por un HT durante 10 años Material y métodos: Inclusión consecutiva de todos los pacientes con EAo candidatos a TAVI entre enero del 2012 y julio del 2021 para seleccionar el mejor tratamiento, incluyendo además Cirugía de reemplazo valvular aórtico (CRVA) y Tratamiento médico conservador (TMC). Resultados: De 841 pacientes, se asignaron a TAVI 455 (53%), CRVA 213 (24%) y TMC 183 (23%). El porcentaje asignado a TAVI aumentó con el tiempo de 48 a 62% (p < 0,05). Los pacientes que fueron a TAVI, con respecto a los enviados a CRVA, eran mayores (86 ± 7 vs 83 ± 7 años), con mayor EUROSCORE II (6,2, IC95% 5,7-6,6 vs 5,6, IC95% 4,4-6,5) y más frágiles (1,62 ± 1 vs 0,91 ± 1), en todos los casos p <0,01. La sobrevida actuarial (IC 95%) a 1 y a 2 años fue, para TAVI 88% (84-91%) y 82% (77-86%), para CRVA 83% (76-88%) y 78% (70-84%) y para TMC 70% (60-87%) y 59% (48-68%) respectivamente (p <0,001). Conclusiones: Durante los primeros 10 años de establecido un Heart Team para la toma de decisiones en EAo, se asignaron a TAVI aproximadamente la mitad y el resto se asignó por mitades a cirugía u observación. La sobrevida de los pacientes intervenidos fue similar a 2 años y mayor que la de los no intervenidos.

ABSTRACT As transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) became widespread, the need for a Heart Team (HT) arose to choose the best treatment. There are few reports regarding its usefulness. Objectives: To analyze treatment outcomes in patients with AS evaluated by a HT for 10 years. Methods: Consecutive enrollment of all patients with AS who were candidates for TAVI between January 2012 and July 2021 to choose the best treatment, including surgical aortic valve replacement (SAVR) and conservative medical management (CMM). Results: Out of 841 patients, 455 were assigned to TAVI (53%), 213 to SAVR (24%), and 183 to CMM (23%). The percentage assigned to TAVI has increased from 48% to 62% over time (p <0.05). Patients who underwent TAVI versus those who underwent SAVR were older (86 ± 7 vs. 83 ± 7 years), had a higher EUROSCORE II (6.2, 95% CI 5.7-6.6 vs. 5.6; 95% CI 4.4-6.5) and were frailer (1.62 ± 1 vs. 0.91 ± 1), in all cases p <0.01. Actuarial survival (95% CI) at 1 and 2 years was 88% (84-91%) and 82% (77-86%) for TAVI, 83% (76-88%) and 78% (70-84%) for SAVR, and 70% (60-87%) and 59% (48-68%) for CMM, respectively (p <0.001). Conclusions: For the first 10 years after a Heart Team was established for AS decision-making, approximately half of the patients were assigned to TAVI, and the rest were equally assigned in halves to either surgery or observation. Survival for patients who received interventions was similar at 2 years and higher than in those who did not.

Características y predictores ecocardiográficos de mortalidad en pacientes intervenidos con TAVI. La importancia de anticiparse al daño cardíaco global / Predictors of late mortality after TAVI: the relevance of early intervention to prevent global deterioration of cardiac function

Introducción: En nuestro medio, el implante percutáneo de prótesis aórtica (TAVI) se encuentra limitado a pacientes más añosos o de mayor riesgo quirúrgico, en quienes frecuentemente se retarda la intervención hasta que presenten signos avanzados de enfermedad. Objetivo: Evaluar el grado de compromiso miocárdico en pacientes sometidos a TAVI y determinar si la magnitud de este compromiso predice los resultados alejados del procedimiento. Métodos: Registro de pacientes sometidos a TAVI en 2 instituciones de Chile. Según la clasificación propuesta por Genereux el año 2017, se clasificaron desde el punto de vista ecocardiográfico como: 1) compromiso de ventrículo izquierdo; 2) compromiso de aurícula izquierda; 3) hipertensión pulmonar / insuficiencia tricuspídea significativa y 4) disfunción de ventrículo derecho. Resultados: Se incluyeron 209 pacientes. Se logró un procedimiento exitoso en 98,6%, registrándose una mortalidad intrahospitalaria de 2,9%. El compromiso cardíaco se extendió más allá de las cavidades izquierdas en 24,7% de los casos (estadíos 3 y 4). A una mediana de seguimiento de 650 días se registró una mortalidad de 26,8%. El compromiso de cavidades derechas (estadíos 3 y 4) se asoció a una mayor mortalidad (39,6% vs 22,1%, log rank p=0,015). En análisis multivariado, este compromiso fue el único factor que de forma independiente predijo mortalidad (HR 1,87, IC 1,01-3,44, p=0,044). Conclusiones: El compromiso de cavidades derechas se asocia a una mayor mortalidad alejada en pacientes sometidos a TAVI. Estos resultados debiesen estimular una derivación precoz de estos pacientes que, aunque añosos y de alto riesgo, tienen buenos resultados intervenidos precozmente.

Background: Locally, Transcatheter Aortic Valve Implantation (TAVI) is limited to very old or high-risk patients, whose intervention is frequently delayed until they develop signs of advanced disease. Aim: To evaluate the degree of myocardial compromise in patients undergoing TAVI and to determine whether the level of this compromise can predict results during follow-up. Methods: Registry of TAVI patients from 2 institutions in Chile. According to the classification proposed by Genereux in 2017, patients were classified based on the echocardiogram as 1) left ventricular compromise; 2) left atrial compromise; 3) pulmonary hypertension / severe tricuspid regurgitation; 4) right ventricular dysfunction. Results: The study included 209 patients. A successful procedure was achieved in 98.6% of cases, with an in-hospital mortality of 2.9%. Cardiac compromise extended beyond left chambers in 24.7% of cases (stages 3 and 4). During follow-up (median of 650 days) mortality was 26.8%. Right chambers involvement (stages 3 and 4) was associated with increased mortality (39.6% vs 22.1%, log rank p=0.015). In multivariate analysis, this compromise was the only factor that independently predicted mortality (HR 1.87, IC 1.01-3.44, p=0,044). Conclusions: Right chambers involvement was associated to increased mortality during follow-up of patients undergoing TAVI. These results should stimulate earlier referral of these high risk and older patients in order to obtain better results following the intervention.

Acute Acquired Immune Thrombocytopenia After Cardiac Surgery: A Challenging Case

Thrombocytopenia is a common condition that recognizes an infinite number of possible causes, especially in specific settings like the one covered in this case report: the postoperative period of cardiac surgery. We report a case of an old male with multiple comorbidities who underwent a coronary angioplasty procedure and aortic valve replacement. He showed severe thrombocytopenia in the postoperative days. Differential diagnosis required a big effort, also for the experts in the field. Our goal was to aggressively treat the patient with prednisolone, platelets, and intravenous immunoglobulins to maximize the prognosis. Our patient developed no complications and was discharged successfully

Transcatheter aortic valve implantation for native aortic valve regurgitation: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective     To evaluate the efficacy of transcatheter aortic valve implantation (TAVI) for native aortic valve regurgitation. Methods    Literature from The Cochrane Library, PubMed, EMbase, Cochrane Controlled Trials Registry, ClinicalTrials.gov and China Biomedical Literature Database from January 2002 to May 2021 were searched by computer. The literature on TAVI or transcatheter aortic valve replacement treatment for simple aortic reflux were collected. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of the literature. Meta-analysis was performed using STATA 14.0 software. Results    A total of 15 studies including 1 394 patients were included. The Newcastle-Ottawa Scales of the studies were≥6 points. The success rate of prosthetic valve implantation was 72.0%-100.0%, and there was no report of serious complications such as surgical death, myocardial infarction, and valve annulus rupture. The 30-day all-cause mortality rate was 6.3% [95%CI (3.4%, 9.1%)]. The incidence of stroke within 30 days and the rate of postoperative permanent pacemaker implantation were 2.0% [95%CI (1.0%, 4.0%)] and 6.0% [95%CI (4.0%, 10.0%)], respectively, and were both within acceptable limits. Conclusion    For patients with simple high-risk aortic regurgitation, TAVI can obtain satisfactory treatment effects and has low postoperative complications rate, and it may be a potential treatment option for such patients.

Effects of multi-disciplinary collaborative nursing on patients with transcatheter aortic valve implantation / 中国胸心血管外科临床杂志

@#Objective     To analyze the clinical intervention effect of multi-disciplinary team (MDT) nursing mode on patients after transcatheter aortic valve implantation (TAVI). Methods     A total of 89 patients who were admitted to our hospital and underwent TAVI surgery from April to December 2021 were selected, including 64 males and 25 females, with an average age of 64.7±11.8 years. The subjects were divided into a MDT intervention group (n=42) and a control group (n=47) according to different postoperative nursing intervention methods. Clinical effectivenesses were compared between the two groups. Results     The left ventricular ejection fraction in the two groups significantly increased on the 7th day after the operation, and the increase in the MDT intervention group was more obvious, with no statistical  difference between the two groups (P=0.14). On the 7th day after surgery, forced vital capacity/predicated value and forced expiratory volume in one second/predicated value significantly decreased, and decreased more significantly in the control group than those in the MDT intervention group with statistical differences (P=0.01). The ICU stay time (P=0.01), hospital stay time (P<0.01) and total postoperative pulmonary complications rate (P=0.03) in the MDT intervention group were significantly shorter or lower than those in the control group The evaluation results of the anxiety and depression status of the patients before and after nursing intervention showed that the scores of anxiety and depression in the two groups were significantly lower than before, and the scores of each scale in the MDT intervention group were lower. The score of quality of life of the two groups significantly improved at the end of 6 months after surgery, and in the MDT intervention group it was significantly higher than that in the control group (P=0.02). Conclusion     MDT intervention mode can promote the rapid recovery of patients after TAVI, effectively reduce the risk of postoperative pulmonary complications, and improve the postoperative quality of life.

Implications of five-year outcomes of PERIGON trial for bioprosthetic aortic valve replacement / 中国胸心血管外科临床杂志

@#For patients with aortic valve disease who require replacement of their native valve, surgical aortic valve replacement (SAVR) has been the standard of care. Due to the hemorrhage and thromboembolic risks of long-term anticoagulation therapy for mechanical prosthesis, bioprosthetic aortic valve replacement (AVR) has a trend to be used in younger patients, which raising the concern for the durability of bioprosthetic valves. The newly published 5-year outcomes of PERIGON trial, with no structural valve deterioration, again demonstrated the favorable durability of the new generation bioprosthetic valves, further providing the evidence of using bioprosthetic AVR in younger patients. At the meantime, the rapid progress of transcatheter aortic valve implantation (TAVI) has brought a new treatment option. For younger patients with low risks, choosing SAVR or TAVI becomes a critical decision. This paper reviews the outcomes of PERIGON trial and its implications to the clinical practice and research of bioprosthetic AVR.

Protective effect of J-Valve transapical aortic Valve replacement in patients with aortic stenosis with low coronary ostium / 中华胸心血管外科杂志

Objective:To investigate the safety and efficacy of J-valve transapical catheter aortic Valve replacement(TA-TAVI) in the early treatment of aortic stenosis with low coronary ostium.Methods:From January 2020 to April 2022, 20 patients with aortic stenosis with coronary opening height ≤10 mm who underwent TA-TAVI treatment in the Valve Surgery Center of Beijing Anzhen Hospital Affiliated to Capital Medical University were enrolled retrospectively. All patients underwent preoperative imaging screening, and 5 patients underwent preoperative coronary artery protection: The height of coronary artery opening was less than 5 mm in 3 cases. 2 cases had stent stenosis & LT after coronary artery stenting 50%, and the position of the coronary artery opening was less than 8mm. The postoperative complications, mortality and cardiac function prognosis of TA-TAVI were analyzed.Results:There were 5 males and 15 females. The average age of the whole group was(73.00±6.20) years. Transthoracic echocardiography showed that all patients had severe aortic valve stenosis, and 85% of the patients had NYHA grade Ⅲ-Ⅳ, and 80% of the patients had aortic valve stenosis with insufficiency. The mean height of left coronary artery opening was(9.07±3.70) mm. RCA(11.39±3.00) mm; The opening height of coronary artery was ≤5 mm in 3 cases(left 7.5%), 5-8 mm in 5 cases(12.5%), and 8-10mm in 16 cases(40.0%). Mean aortic sinus(valsalva) diameter: Left(30.06±5.90) mm; Right(28.50±5.68) mm; Non(29.96±6.15) mm. J-valve Valve was successfully implanted through apical catheter in all patients, most of whom were size 23. CPB was performed in 2 patients at the same time, permanent pacemaker was inserted in 2 patients, and moderate or above perivalvular leakage was found in 0 patients. All patients had TNI( P=0.12) and MYO( P=0.03) before and 24 hours after operation. None of the 5 patients underwent coronary artery stenting. None of the 5 patients died within 30 days after the operation. Ta-tavi is effective 30 days after operation, with low complication rate and good prognosis of cardiac function. Conclusion:J-valve transapical catheter aortic Valve replacement is safe and effective in the treatment of aortic stenosis with low coronary ostium.

Expert recommendations for standardized perioperative management after transapical transcatheter aortic valve implantation / 中国胸心血管外科临床杂志

@#The technique of transcatheter aortic valve implantation has become increasingly mature. Although the transapical approach has a certain degree of minimally invasive trauma, it still has the characteristics such as heart beating without cardiopulmonary bypass, and the low technical requirements of catheter guide wire. In particular, the valve path is short and coaxial, which is easy to manipulate, and pure regurgitation and stenosis can be easily operated and are not subject to the limit of peripheral artery stenosis. It is still one of China's main approaches for transcatheter aortic valve replacement. Its perioperative management still has specific features and differs from the femoral artery approach. In addition, there is little relevant literature abroad. Therefore, domestic experts in this field were organized to discuss the development of perioperative management specifications to provide reference and techniques support for developing this field in China and further improve the quality of clinical operation and perioperative management. It will provide more safe and more effective medical services to these patients.

Research progress of coronary artery occlusion associated with transcatheter aortic valve implantation / 中国胸心血管外科临床杂志

@#Transcatheter aortic valve implantation (TAVI) has become the main treatment for elderly patients with middle and high risk aortic stenosis. However, coronary artery occlusion (CAO) related to TAVI is a very serious complication, which often leads to poor prognosis. Therefore, active preoperative prevention is particularly important. Preoperative computed tomography evaluation, bioprosthetic or native aortic scallop intentional laceration and chimney stent implantation technology can prevent TAVI-related coronary orifice obstruction. Ensuring commissural alignment during operation can reduce the occurrence of coronary occlusion, but its long-term prognosis needs further study. In addition, percutaneous coronary intervention is the main treatment, but there are problems such as difficult coronary access after TAVI. This article summarized the research progress in the mechanism, prevention and treatment of CAO related to TAVI.

Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve with Aortic Stenosis: a Meta-Analysis and Trial Sequential Analysis

Abstract Objectives: Bicuspid aortic valve (BAV) is an important aetiology of aortic stenosis and the use of transcatheter aortic valve implantation (TAVI) has not been fully explored in this cohort. This systematic review and meta-analysis compared the outcomes of TAVI in stenotic BAV against tricuspid aortic valve (TAV). Methods: An electronic literature search was performed in PubMed, MEDLINE, EMBASE, and Scopus to identify all studies comparing TAVI in stenotic BAV versus TAV. Only studies comparing TAVI in BAV versus TAV were included, without any limit on the study date. Primary endpoints were 30-day and 1-year mortality, while secondary endpoints were postoperative rates of stroke, acute kidney injury (AKI), and permanent pacemaker (PPM) requirement. A trial sequential analysis (TSA) was performed for all endpoints to understand their significance. Results: Thirteen studies met the inclusion criteria (917 BAV and 3079 TAV patients). The BAV cohort was younger (76.8±7.43 years vs. 78.5±7.12 years, P=0.02), had a higher trans-aortic valve gradient (P=0.02), and larger ascending aortic diameters (P<0.0001). No significant difference was shown for primary (30-day mortality [P=0.45] and 1-year mortality [P=0.41]) and secondary endpoints (postoperative stroke [P=0.49], AKI [P=0.14], and PPM requirement [P=0.86]). The BAV group had a higher rate of significant postoperative aortic regurgitation (P=0.002). TSA showed that there was sufficient evidence to conclude the lack of difference in PPM requirements, and 30-day and 1-year mortality between the two cohorts. Conclusion: TAVI gives satisfactory outcomes for treating stenotic BAV and should be considered clinically.

Development of platelet change characteristics and antithrombotic strategies after transcatheter aortic valve replacement / 中国综合临床

Transcatheter aortic valve implantation (TAVI) is an emerging, minimally invasive surgical procedure for the safe and effective treatment of aortic valve lesions,and with the advancement of medical research and surgical techniques, the population for TAVI is gradually expanding,but, the characteristics of platelet changes after TAVI and the best antithrombotic strategy in the perioperative period are not conclusive. We review the characteristics of platelet changes and related factors after TAVI, and the outcomes of clinical studies related to different antithrombotic treatments in the perioperative period, in order to discuss the individualized antithrombotic strategy after TAVI.

Transapical aortic valve implantation using J-Valve? system for high-risk patients with aortic regurgitation: mid-stage of 1 year follow-up / 中华胸心血管外科杂志

Objective:To analysis the mid-stage prognosis of transapical aortic valve implantation(TA-TAVI) using J-Valve? system for the treatment of high-risk aortic regurgitation(AR) patients.Methods:Data of 25 patients with aortic regurgitation who had underwent transapical aortic valve implantation using J-Valve? system were collected in the Second Affiliated Hospital of Medical College of ZheJiang University from September 2016 to June 2020 . Analysis and summarize their postoperative all-cause mortality, the incidence of adverse events and the improvement in cardiac function.Results:There were 25 patients, including 19 males, the age rage from 59-83 years, the average age was(72.3±27.11) years. The levels of aortic regurgitation was evaluated by transthoracic echocardiography preoperatively, showed that severe AR accounted for 88%. The New York Heart Association(NYHA) of grade 3 or above was 92%. The most common comorbidity was hypertension, accounted for 68%. Coronary heart disease and history of cardiac surgery was 5 and 3 relatively in this study. The Society of Thoracic Surgeons score before surgery was 1.511%-27.674%, the average of STS score was 4.27(2.914-6.033)%. Successful J-Valve implantation was obtained in all 25 cases, no conversion to thoracotomy. After surgery, 2 patients required permanent pacemaker implantation, 1 patient needed continuous renal replacement therapy(CRRT) due to acute kidney injury, 1 occurred moderate or above paravalvular leak. The results showed good therapeutic effects in early-stage, low incidences of adverse events. The continued improvement of cardiac function and ventricular reverse remodeling could be observed in mid-stage.Conclusion:In this study, we can summarize that high-risk patients with aortic regurgitation treated with transapical aortic valve implantation using J-Valve? system can acquire great perioperative safety and mid-stage prognosis.

Clinical outcomes of transcatheter aortic valve implantation in oncology versus non-oncology patients with severe aortic stenosis: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To compare the clinical outcomes of transcatheter aortic valve implantation (TAVI) in oncology and non-oncology patients with severe aortic stenosis (AS). Methods    A computer-based search in PubMed, The Cochrane Library, EMbase, CBM, CNKI and Wanfang databases from their date of inception to December 2021 was performed, together with reference screening, to identify eligible clinical trials. Two investigators screened the articles, extracted data, and evaluated quality independently. RevMan 5.3 and Stata 12.0 softwares were used for meta-analysis. Results    The selected 8 cohort studies contained 57 988 patients, including 12 335 cancer patients and 45 653 non-cancer patients. The results of meta-analysis showed that in patients with cancer, the 30-day mortality [OR=0.74, 95%CI (0.65, 0.84), I2=0%, P<0.000 01], stroke [OR=0.87, 95%CI (0.76, 0.99), I2=0%, P=0.04] and acute kidney injury [OR=0.81, 95%CI (0.76, 0.85), I2=49%, P<0.000 01] were lower than those in patients without cancer. The 1-year mortality [OR=1.46, 95%CI (1.15, 1.86), I2=62%, P=0.002] and late mortality [OR=1.51, 95%CI (1.24, 1.85), I2=61%, P<0.000 1] were higher in patients with cancer. Conclusion    It is effective and safe in cancer patients with severe AS undergoing TAVI. However, compared with patients without cancer, it is still high in long-term mortality, and further study of the role of TAVI in cancer patients with AS is necessary.

The Impact of Transcatheter Aortic Valve Implantation (TAVI) on Serum Apelin Levels in Patients with Aortic Valvular Stenosis

Abstract Introduction: In this study, we aimed to investigate the impact of transcatheter aortic valve implantation (TAVI) on serum apelin levels in patients with severe symptomatic aortic valve stenosis (AS). Methods: Forty-six consecutive patients (76.9±7.4 years, n=27 women) who underwent TAVI and 45 age- and sex-matched control subjects were included in the study. Echocardiographic parameters, serum apelin, pro-brain natriuretic peptide (Pro-BNP), and troponin I levels were compared between the groups. In addition, the preprocedural and first-month follow-up echocardiographic parameters and serum apelin values of TAVI patients were compared. Results: Serum median troponin I and Pro-BNP levels were significantly higher and serum apelin levels were significantly lower in TAVI patients before TAVI procedure than in the control subjects (P<0.001, for all). Median troponin I and Pro-BNP levels were significantly decreased and apelin levels were significantly increased after TAVI procedure compared to the peri-procedural levels. There was a significant and moderate negative correlation between Pro-BNP and apelin levels measured before and after TAVI procedure. A statistically significant and strong negative correlation was found between aortic valve area and Pro-BNP level before TAVI procedure, while a statistically significant but weak positive correlation was found between valve area and apelin level. Conclusion: In our study, apelin levels were significantly lower and Pro-BNP levels were higher in AS patients compared with the control group. Moreover, after TAVI procedure, a significant increase in apelin levels and a significant decrease in Pro-BNP levels were observed. There was also a negative and moderate correlation between apelin and Pro-BNP levels.

The role of the axillary artery as a second access choice in TAVI procedures

Abstract With transcatheter aortic valve implantation (TAVI) technology expanding its indications for low-risk patients, the number of TAVI-eligible patients will globally grow, requiring a better understanding about the second-best access choice. Regarding the potential access sites, the transfemoral retrograde route is recognized as the standard approach and first choice according to current guidelines. However, this approach is not suitable in up to 10-15% of patients, for whom an alternative non-femoral access is required. Among the alternative non-femoral routes, the transaxillary approach has received increasing recognition due to its proximity and relatively straight course from the axillary artery to the aortic annulus, which provides a more accurate device deployment. Here we discuss some particular aspects of the transaxillary access, either percutaneously performed or by cutdown dissection.

Sobrevida alejada de los pacientes con estenosis aórtica severa tratados con implante valvular percutáneo / Long-term survival of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Background: Transcatheter aortic valve implantation (TAVI) is an effective and safe option for low, medium and high-risk patients with severe aortic stenosis (SAS). Aim: To analyze the clinical results and long-term survival of TAVI in our center. Material and Methods: Prospective analysis of 53 patients aged 73 ± 10 years with a Society of Thoracic Surgeons (STS) score of 7.3 ± 3.9%. Results: In 96% a transfemoral access was used and, in most patients, ProGlides™ as vascular closure device was used. General anesthesia and conscious sedation were used in 79 and 21% of cases, respectively. Fifty-three valves were implanted, 42 self-expandable (SEV) and 11 balloon-expandable (Edwards Sapiens). The implant was successful in 49 patients (92,4%). The transaortic gradient after TAVI was almost zero mmHg in all patients and one had a severe aortic regurgitation. Permanent pacemakers were needed in 17% of patients. Two patients had a pericardial effusion, and one had a major vascular complication. No strokes were recorded, and 30-day mortality was 3.7%. At long-term follow up (23.4 ± 21.6 months) the global survival was 85% and the rate of cardiovascular mortality was 5.9%. Conclusions: In this series of intermediate to high-risk patients, TAVI was associated with an excellent early and long-term survival.