ABSTRACT
Introduction: Percutaneous transfemoral access approach for the transcatheter aortic valve implantation (TAVI) is still associated with significant vascular complications. Hence, evaluation of best techniques for the reduction of vascular injury via the femoral access remains a key subject of research. Aim: We report on a single centre's experience with TAVI performed via the Femoral Artery Minimal Surgical Access (MSA) and percutaneous approach (PC). The primary endpoints were to evaluate the incidents of vascular complications by comparing the MSA versus the PC approach according to the VARC-2 criteria. The secondary endpoint included the impact of vascular complications on the in-hospital 30-day mortality and morbidity. Material and methods: Between June 2010 and September 2020, two hundred and thirty-seven consecutive patients who underwent TAVI for severe symptomatic aortic stenosis in our department were divided into two groups: patients treated using the femoral artery minimal surgical access (n = 173), and patients treated using the percutaneous approach (n = 64). Results: Overall rate of access site complications according the VARC-2 were significantly more frequent in the percutaneous cohort (n = 12/64, 18.8% vs n = 2/173, 1.1%, p = 0.0012). The minor access complications including haematoma, bleeding, aneurysm, dissection, stenosis, seroma and infection were more frequent in the PC group (n = 8/64, 12.5% vs n = 2/173, 1.1%, p < 0.001). There were no major access site complications and hospital deaths in the MSA group, which was statistically significant (p < 0.001). Major access complications (n = 4, 6.3%, p < 0.001) and hospital death (n = 2, 3.1%, p < 0.001) were found in the PC cohort. Conclusions: The minimal surgical access approach provided direct and controlled access and significantly reduced the incidence of access site vascular complications in our TAVI patients. It also significantly reduced the in-hospital vascular-related mortality and morbidity. Though both approaches are complementary to each other, minimal surgical access approach would be a better choice for a calcified or tortuous femoral artery, and for a relatively small femoral artery diameter.
ABSTRACT
INTRODUCTION: Fulminant hepatic failure is a serious disease with significant mortality and morbidity. Identifying the exact cause of hepatic failure and predicting prognosis is of paramount importance in managing such patients. Drug-induced liver injury is a common but challenging entity to treat. The use of newer drugs and medications with previously unknown hepatotoxicity add to the challenges faced by treating physicians. Quetiapine is an antipsychotic that has rarely been linked to acute liver injury. In the present work we describe a case of fulminant hepatic failure secondary to use of quetiapine. CASE PRESENTATION: A 59-year-old Caucasian woman with known Parkinson's disease was being treated with quetiapine for hallucinations. She was referred to our hospital with yellow discoloration of the sclera and later on developed clinical features suggestive of hepatic encephalopathy. A diagnosis of fulminant hepatic failure was made following her admission to the intensive care unit. Her condition improved after discontinuing the drug and providing the standard supportive treatment. CONCLUSIONS: Our findings in the present report emphasize the importance of keeping an open mind in cases of fulminant hepatic failure. As drug-induced hepatotoxicity is the most common cause of fulminant hepatic failure in many parts of the world, consideration should be given to the medication(s) patients receive as the potential cause and a review of this list should be part of the clinical care given.
