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1.
JACC Case Rep ; 1(5): 815-818, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-34316938

RESUMO

A 67-year-old man was sent to our center because of progressively worsening chest pain. A giant ruptured thoracic aortic aneurysm was documented. We performed a successfully rescue snorkel technique for thoracic endovascular aortic repair failure because of type IA endoleak after the first endoprosthesis implantation. The patient was discharged after 6 weeks. (Level of Difficulty: Advanced.).

2.
JACC Cardiovasc Interv ; 5(2): 207-14, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22361606

RESUMO

OBJECTIVES: The purpose of this study was to evaluate the incidence of vascular complications and the predictors of Prostar failure for a "true percutaneous approach" in transfemoral transcatheter aortic valve implantation (TAVI). BACKGROUND: Safety and efficacy of a true percutaneous approach in transfemoral-TAVI has not been described in a large prospective cohort. METHODS: Among 264 patients included in our prospective TAVI database (October 2006 to December 2010), transfemoral-TAVI was performed in 170 patients. True percutaneous approach was performed in 142 consecutive patients since March 2008. Successful closure with Prostar was defined as adequate hemostasis without Prostar-related vascular complications. We compared the incidence of vascular complications in our early and late experience. RESULTS: Patients were 83.0±7.2 years old and with a EuroSCORE of 24.0±11.6%. The Edwards valve (Edwards Lifesciences, Irvine, California) (18- to 24-F) was used in 109 cases and the CoreValve (Medtronic, Minneapolis, Minnesota) (18-F) in 31. The sheath outer diameter to minimal femoral diameter ratio (SFAR) was 0.96±0.14. Successful closure was achieved in 90.7%, and was significantly increased (95.7% vs. 85.7%, p=0.047) in the late experience group. Cross-over to surgery was required in 3.6%. Vascular complications occurred in 20.0%, and were significantly lower in the late experience group (11.4% vs. 28.6%, p=0.012). Major vascular complications (2.9% vs. 14.3%, p=0.018) were decreased in the late experience group. Early experience (hazard ratio [HR]: 3.66, 95% confidence interval [CI]: 1.04 to 13.89, p=0.047) and SFAR (HR: 110.80, 95% CI: 1.15 to 10,710.73, p=0.044) predicted Prostar failure by univariate analysis. CONCLUSIONS: Experience reduced major vascular complications in a true percutaneous approach for transfemoral-TAVI. Further application of this less invasive strategy is feasible and may be beneficial, in this high-risk patient cohort.


Assuntos
Estenose da Valva Aórtica/patologia , Valva Aórtica/patologia , Competência Clínica , Implante de Prótese de Valva Cardíaca/instrumentação , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/cirurgia , Intervalos de Confiança , Falha de Equipamento , Feminino , Indicadores Básicos de Saúde , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Aprendizagem , Curva de Aprendizado , Masculino , Estudos Prospectivos , Estatísticas não Paramétricas , Falha de Tratamento
3.
JACC Cardiovasc Interv ; 4(8): 851-8, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21851897

RESUMO

OBJECTIVES: This study sought to evaluate the incidence, impact, and predictors of vascular complications in transcatheter aortic valve implantation (TAVI). BACKGROUND: Vascular complications increase morbidity and mortality in transfemoral TAVI; however, there remains a paucity of data describing these serious events. METHODS: We performed a prospective cohort study of 130 consecutive transfemoral TAVI recipients. Vascular complications were defined by the Valve Academic Research Consortium (VARC) criteria. The ratio of the sheath outer diameter (in millimeters) to the minimal femoral artery diameter (in millimeters) defined the sheath to femoral artery ratio (SFAR). RESULTS: In our cohort of elderly patients (83.3 ± 5.9 years), the logistic EuroScore was 25.8% ± 11.9%. The Edwards valve was used in 102 cases (18- to 24-F) and the CoreValve in 27 (18-F). The minimal femoral artery diameter was 8.17 ± 1.14 mm, and the calcification (0 to 3) and tortuosity scores (0 to 3) were 0.58 ± 0.72 and 0.28 ± 0.53, respectively. The mean sheath diameter was 8.10 ± 0.82 mm, and the mean SFAR was 0.99 ± 0.16. Vascular complications occurred in 27.6% (VARC major: 17.3%, minor: 10.2%), and major vascular complications predicted 30-day mortality (22.7% vs. 7.6%, p = 0.049). The SFAR (hazard ratio [HR]: 186.20, 95% confidence interval [CI]: 4.41 to 7,855.11), center experience (HR: 3.66, 95% CI: 1.17 to 11.49), and femoral calcification (HR: 3.44, 95% CI: 1.16 to 10.17) predicted major complications by multivariate analysis. An SFAR threshold of 1.05 (area under the curve = 0.727) predicted a higher rate of VARC major complications (30.9% vs. 6.9%, p = 0.001) and 30-day mortality (18.2% vs. 4.2%, p = 0.016). CONCLUSIONS: Vascular complications in transfemoral TAVI are relatively frequent. VARC major vascular complications increase 30-day mortality and are predicted by experience, femoral calcification, and SFAR. Routine application of SFAR will improve patient selection for transfemoral TAVI and may improve outcome.


Assuntos
Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco/efeitos adversos , Artéria Femoral , Implante de Prótese de Valva Cardíaca/efeitos adversos , Doenças Vasculares/etiologia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Catéteres , Desenho de Equipamento , Feminino , Artéria Femoral/diagnóstico por imagem , França , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Estudos Prospectivos , Desenho de Prótese , Radiografia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/mortalidade , Doenças Vasculares/terapia
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