Transcatheter Aortic Valve Replacement by a Novel Suprasternal Approach

Pablo Codner, Daniel Pugliese, Rémi Kouz, Amisha Patel, Cheng Han Chen, Juan A. Terre, Kyle M. Eudaley, Tamim Nazif, Torsten P. Vahl, Isaac George, Omar K. Khalique, Rebecca T. Hahn, Martin B. Leon, Susheel Kodali, Michael Borger

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Transcatheter aortic valve replacement (TAVR) provides therapy for patients with severe aortic stenosis at extreme, high, or intermediate surgical risk. Transfemoral access has been the preferred access route; however, this approach is not suitable for many TAVR candidates. A suprasternal approach may allow for earlier ambulation and shorter hospital stay as compared with other, nontransfemoral approaches. Methods: A total of 11 patients with unsuitable transfemoral access underwent suprasternal TAVR. Propensity matching was used to compare suprasternal patients to patients undergoing transaortic, transapical, and trans-subclavian TAVR. Results: Groups were well matched for baseline characteristics. A self-expanding valve device was used in 6 (54.5%) and a balloon-expandable valve in 5 (45.5%) of the 11 patients treated by the suprasternal route. Suprasternal and trans-subclavian patients were able to ambulate earlier than patients treated by the transaortic route, a median 1.6 days (interquartile range [IQR]: 0.9 to 1.8), 1.6 days (IQR: 0.9 to 2.7), and 3.9 days (IQR: 1.9 to 4.5) after the procedure for suprasternal, trans-subclavian, and transaortic patients, respectively (p = 0.001). Length of hospitalization was shorter for patients treated by suprasternal or trans-subclavian access in comparison with patients treated by the transaortic or transapical approach: median 4 days (IQR: 3 to 8) and 4 days (IQR: 4 to 8) versus 8 days (IQR: 6 to 14) and 6 days (IQR: 7 to 11) for suprasternal and trans-subclavian versus transaortic and transapical, respectively (p = 0.01). Conclusions: Suprasternal and trans-subclavian access are associated with earlier ambulation and shorter hospitalization than other nontransfemoral TAVR routes, without an increase in complications. Further study is required to determine if suprasternal is the alternative access of choice for TAVR patients with poor transfemoral vasculature.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

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Early Ambulation
Hospitalization
Transcatheter Aortic Valve Replacement
Aortic Valve Stenosis
Length of Stay
Equipment and Supplies
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter Aortic Valve Replacement by a Novel Suprasternal Approach. / Codner, Pablo; Pugliese, Daniel; Kouz, Rémi; Patel, Amisha; Chen, Cheng Han; Terre, Juan A.; Eudaley, Kyle M.; Nazif, Tamim; Vahl, Torsten P.; George, Isaac; Khalique, Omar K.; Hahn, Rebecca T.; Leon, Martin B.; Kodali, Susheel; Borger, Michael.

In: Annals of Thoracic Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Codner, P, Pugliese, D, Kouz, R, Patel, A, Chen, CH, Terre, JA, Eudaley, KM, Nazif, T, Vahl, TP, George, I, Khalique, OK, Hahn, RT, Leon, MB, Kodali, S & Borger, M 2018, 'Transcatheter Aortic Valve Replacement by a Novel Suprasternal Approach', Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2017.10.055
Codner, Pablo ; Pugliese, Daniel ; Kouz, Rémi ; Patel, Amisha ; Chen, Cheng Han ; Terre, Juan A. ; Eudaley, Kyle M. ; Nazif, Tamim ; Vahl, Torsten P. ; George, Isaac ; Khalique, Omar K. ; Hahn, Rebecca T. ; Leon, Martin B. ; Kodali, Susheel ; Borger, Michael. / Transcatheter Aortic Valve Replacement by a Novel Suprasternal Approach. In: Annals of Thoracic Surgery. 2018.
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abstract = "Background: Transcatheter aortic valve replacement (TAVR) provides therapy for patients with severe aortic stenosis at extreme, high, or intermediate surgical risk. Transfemoral access has been the preferred access route; however, this approach is not suitable for many TAVR candidates. A suprasternal approach may allow for earlier ambulation and shorter hospital stay as compared with other, nontransfemoral approaches. Methods: A total of 11 patients with unsuitable transfemoral access underwent suprasternal TAVR. Propensity matching was used to compare suprasternal patients to patients undergoing transaortic, transapical, and trans-subclavian TAVR. Results: Groups were well matched for baseline characteristics. A self-expanding valve device was used in 6 (54.5{\%}) and a balloon-expandable valve in 5 (45.5{\%}) of the 11 patients treated by the suprasternal route. Suprasternal and trans-subclavian patients were able to ambulate earlier than patients treated by the transaortic route, a median 1.6 days (interquartile range [IQR]: 0.9 to 1.8), 1.6 days (IQR: 0.9 to 2.7), and 3.9 days (IQR: 1.9 to 4.5) after the procedure for suprasternal, trans-subclavian, and transaortic patients, respectively (p = 0.001). Length of hospitalization was shorter for patients treated by suprasternal or trans-subclavian access in comparison with patients treated by the transaortic or transapical approach: median 4 days (IQR: 3 to 8) and 4 days (IQR: 4 to 8) versus 8 days (IQR: 6 to 14) and 6 days (IQR: 7 to 11) for suprasternal and trans-subclavian versus transaortic and transapical, respectively (p = 0.01). Conclusions: Suprasternal and trans-subclavian access are associated with earlier ambulation and shorter hospitalization than other nontransfemoral TAVR routes, without an increase in complications. Further study is required to determine if suprasternal is the alternative access of choice for TAVR patients with poor transfemoral vasculature.",
author = "Pablo Codner and Daniel Pugliese and R{\'e}mi Kouz and Amisha Patel and Chen, {Cheng Han} and Terre, {Juan A.} and Eudaley, {Kyle M.} and Tamim Nazif and Vahl, {Torsten P.} and Isaac George and Khalique, {Omar K.} and Hahn, {Rebecca T.} and Leon, {Martin B.} and Susheel Kodali and Michael Borger",
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AU - Codner, Pablo

AU - Pugliese, Daniel

AU - Kouz, Rémi

AU - Patel, Amisha

AU - Chen, Cheng Han

AU - Terre, Juan A.

AU - Eudaley, Kyle M.

AU - Nazif, Tamim

AU - Vahl, Torsten P.

AU - George, Isaac

AU - Khalique, Omar K.

AU - Hahn, Rebecca T.

AU - Leon, Martin B.

AU - Kodali, Susheel

AU - Borger, Michael

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Transcatheter aortic valve replacement (TAVR) provides therapy for patients with severe aortic stenosis at extreme, high, or intermediate surgical risk. Transfemoral access has been the preferred access route; however, this approach is not suitable for many TAVR candidates. A suprasternal approach may allow for earlier ambulation and shorter hospital stay as compared with other, nontransfemoral approaches. Methods: A total of 11 patients with unsuitable transfemoral access underwent suprasternal TAVR. Propensity matching was used to compare suprasternal patients to patients undergoing transaortic, transapical, and trans-subclavian TAVR. Results: Groups were well matched for baseline characteristics. A self-expanding valve device was used in 6 (54.5%) and a balloon-expandable valve in 5 (45.5%) of the 11 patients treated by the suprasternal route. Suprasternal and trans-subclavian patients were able to ambulate earlier than patients treated by the transaortic route, a median 1.6 days (interquartile range [IQR]: 0.9 to 1.8), 1.6 days (IQR: 0.9 to 2.7), and 3.9 days (IQR: 1.9 to 4.5) after the procedure for suprasternal, trans-subclavian, and transaortic patients, respectively (p = 0.001). Length of hospitalization was shorter for patients treated by suprasternal or trans-subclavian access in comparison with patients treated by the transaortic or transapical approach: median 4 days (IQR: 3 to 8) and 4 days (IQR: 4 to 8) versus 8 days (IQR: 6 to 14) and 6 days (IQR: 7 to 11) for suprasternal and trans-subclavian versus transaortic and transapical, respectively (p = 0.01). Conclusions: Suprasternal and trans-subclavian access are associated with earlier ambulation and shorter hospitalization than other nontransfemoral TAVR routes, without an increase in complications. Further study is required to determine if suprasternal is the alternative access of choice for TAVR patients with poor transfemoral vasculature.

AB - Background: Transcatheter aortic valve replacement (TAVR) provides therapy for patients with severe aortic stenosis at extreme, high, or intermediate surgical risk. Transfemoral access has been the preferred access route; however, this approach is not suitable for many TAVR candidates. A suprasternal approach may allow for earlier ambulation and shorter hospital stay as compared with other, nontransfemoral approaches. Methods: A total of 11 patients with unsuitable transfemoral access underwent suprasternal TAVR. Propensity matching was used to compare suprasternal patients to patients undergoing transaortic, transapical, and trans-subclavian TAVR. Results: Groups were well matched for baseline characteristics. A self-expanding valve device was used in 6 (54.5%) and a balloon-expandable valve in 5 (45.5%) of the 11 patients treated by the suprasternal route. Suprasternal and trans-subclavian patients were able to ambulate earlier than patients treated by the transaortic route, a median 1.6 days (interquartile range [IQR]: 0.9 to 1.8), 1.6 days (IQR: 0.9 to 2.7), and 3.9 days (IQR: 1.9 to 4.5) after the procedure for suprasternal, trans-subclavian, and transaortic patients, respectively (p = 0.001). Length of hospitalization was shorter for patients treated by suprasternal or trans-subclavian access in comparison with patients treated by the transaortic or transapical approach: median 4 days (IQR: 3 to 8) and 4 days (IQR: 4 to 8) versus 8 days (IQR: 6 to 14) and 6 days (IQR: 7 to 11) for suprasternal and trans-subclavian versus transaortic and transapical, respectively (p = 0.01). Conclusions: Suprasternal and trans-subclavian access are associated with earlier ambulation and shorter hospitalization than other nontransfemoral TAVR routes, without an increase in complications. Further study is required to determine if suprasternal is the alternative access of choice for TAVR patients with poor transfemoral vasculature.

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