ABSTRACT
The axillary artery seems an interesting alternative in nonfemoral transaortic valve replacement (TAVR) patients. This study describes our experience with this technique and its short-term follow-up results. This is a retrospective single center study. All axillary TAVR performed in our department between 2015 and 2017 were included in the study. Mean follow-up was 13.2 ± 9.5 months. All reporting was done according to the VARC-2 criteria. During the period covered, 43 patients had an axillary TAVR. Most patients were men (62.7%), had a mean age of 83.9 ± 5.3 years and presented with EuroSCORE I, II, and STS score of 27.9 ± 13.5%, 5.6 ± 4.9%, and 7.7 ± 4.05%, respectively. Vascular access was successful in all patients with a higher frequency of left approach (69.7%, nâ¯=â¯30). Both Medtronic CoreValve 37.2% (nâ¯=â¯16) and Edwards Sapien3 62.8% (nâ¯=â¯27) valves were used. An apical Certitude delivery system was preferentially used (24/27) in the latter group. There were no reported instances of valve migration or need for a second valve implantation. A single case (2.3%) of arterial vascular complication was reported. Central neurologic morbidity was 2.3%. No patient experienced brachial plexus injury. A pacemaker was implanted in 18.6% of cases (nâ¯=â¯8), with no significant difference between the 2 valves patient groups (S3 14.8% vs CV 25%, P 0.67). The 30-day mortality was 6.9% (nâ¯=â¯3) and 1-year survival was 86% [95% CI 72.6, 93.4]. Axillary TAVR is associated with acceptable morbidity, mortality, and leads to satisfactory short-term clinical outcomes. It has the potential to become the main alternative access route in nonfemoral TAVR patients.
Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/pathology , Aortic Valve/surgery , Axillary Artery , Calcinosis/surgery , Catheterization, Peripheral/methods , Peripheral Arterial Disease/complications , Transcatheter Aortic Valve Replacement/methods , Aged , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/mortality , Axillary Artery/diagnostic imaging , Calcinosis/complications , Calcinosis/diagnostic imaging , Calcinosis/mortality , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/mortality , Female , Heart Valve Prosthesis , Humans , Male , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/mortality , Postoperative Complications/etiology , Prosthesis Design , Punctures , Retrospective Studies , Risk Factors , Time Factors , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/instrumentation , Transcatheter Aortic Valve Replacement/mortality , Treatment OutcomeABSTRACT
The user's perspective on the notion of nursing ethics is essential, in a context where the health democracy is becoming increasingly important. However, at a time when treatment is becoming cross-disciplinary, the user is right to reflect on the existence of distinct codes of ethics for each profession. To take into account the interest of the patient, a core foundation common to all the different professions could be envisaged, from the point of view of the ethics of care.