Minimum-incision transsubclavian transcatheter aortic valve replacement with balloon-expandable valve for dialysis patients.
J Cardiol
; 84(2): 93-98, 2024 Aug.
Article
em En
| MEDLINE
| ID: mdl-38215966
ABSTRACT
BACKGROUND:
Dialysis patients undergoing transcatheter aortic valve replacement (TAVR) face increased risk and have poorer outcomes than non-dialysis patients. Moreover, TAVR in dialysis patients using an alternative approach is considered extremely risky and little is known about the outcomes. We routinely perform minimum-incision transsubclavian TAVR (MITS-TAVR), which is contraindicated for transfemoral (TF) TAVR. This study aimed to evaluate the outcomes of MITS-TAVR compared with those of TF-TAVR in dialysis patients.METHODS:
This single-center, observational study included 79 consecutive dialysis patients who underwent MITS-TAVR (MITS group, nâ¯=â¯22) or TF-TAVR (TF group, nâ¯=â¯57) under regional anesthesia.RESULTS:
The rates of peripheral artery disease (MITS vs. TF, 72.7â¯% vs. 26.3â¯%; pâ¯<â¯0.01), shaggy aortas (MITS vs. TF, 63.6â¯% vs. 5.26â¯%; pâ¯<â¯0.01), and tortuous aortas (MITS vs. TF, 13.6â¯% vs. 1.75â¯%; pâ¯=â¯0.031) were significantly higher in the MITS group. The 30-day mortality was 2.53â¯% and comparable between the two groups (MITS vs. TF, 4.54â¯% vs. 1.75â¯%; pâ¯=â¯0.479). In the MITS group, 14 patients had ipsilateral dialysis fistulas, and three patients had patent in situ ipsilateral internal thoracic artery grafts; however, no vascular complications were observed. Kaplan-Meier survival curves for the two groups showed no significant difference in the survival rate (at 2â¯years; MITS vs. TF, 77.3â¯% vs. 68.8â¯%; pâ¯=â¯0.840) and freedom from cardiovascular mortality (at 2â¯years; MITS vs. TF, 90.9â¯% vs. 96.5â¯%; pâ¯=â¯0.898). The multivariable Cox proportional hazard model also indicated that survival in the MITS group was not significantly different from that in the TF group (hazard ratio 1.48; 95â¯% confidence interval, 0.77-2.85, pâ¯=â¯0.244). The patency rate of ipsilateral dialysis fistula was 100â¯% during follow-up.CONCLUSION:
The outcome of MITS-TAVR was comparable to that of TF-TAVR in dialysis patients, despite the higher risk of patient characteristics.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Estenose da Valva Aórtica
/
Diálise Renal
/
Substituição da Valva Aórtica Transcateter
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article