RESUMEN
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.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Arteria Axilar , Calcinosis/cirugía , Cateterismo Periférico/métodos , Enfermedad Arterial Periférica/complicaciones , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Arteria Axilar/diagnóstico por imagen , Calcinosis/complicaciones , Calcinosis/diagnóstico por imagen , Calcinosis/mortalidad , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/mortalidad , Femenino , Prótesis Valvulares Cardíacas , Humanos , Masculino , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/mortalidad , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Punciones , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Resultado del TratamientoRESUMEN
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.