Transaortic Transcatheter Aortic Valve Implantation as a second choice over the Transapical access

Background and Aims: In this report, we present our experience with the transaortic transcatheter aortic valve implantation using the SAPIEN valve. The procedural success, 30-day outcome, and survival up to 2years are compared with the transapical access performed in patients in our institution. Material and Methods: Of a total of 282 transcatheter aortic valve implantation patients, 100 consecutive patients had a non-transfemoral approach. The transaortic and transapical access routes were used in 36 and 64 patients, respectively. The transaortic group had a higher mean logistic EuroSCORE (32.6 vs 25.2, p=0.021) and more patients with left ventricular ejection fraction less than 40% (33.3% vs 14.1%, p=0.023). Results: The respective technical success rates for the transaortic and transapical groups were 100% and 95.2% (p=NS). There were significantly more perioperative hemodynamic problems necessitating cardiopulmonary resuscitation or mechanical circulatory support in the transapical group (18.8% vs 2.8%, p=0.023). The transaortic group had a slightly shorter hospital stay (7 vs 8days, p=0.018). The 30-day mortality was 8.6% and 10.9% in the transaortic and transapical group, respectively (p=NS). Combined safety outcome was similar in both groups at 30days. The respective 1-year survival rates for the transaortic and transapical groups were 71.5% and 68.3%, respectively (p=NS). Conclusion: The trans transcatheter aortic valve implantation is a considerable choice to transapical approach. Despite a higher risk patient cohort, the clinical outcome is at least comparable to the transapical transcatheter aortic valve implantation, and it can be utilized as a second choice for patients with prohibitive iliac-femoral anatomy for transfemoral access.Peer reviewe

Does a Completely Accomplished Duplex-based Surveillance Prevent Vein-graft Failure?

AbstractObjectives: to assess the benefits of duplex-based vein-graft surveillance over clinical surveillance with distal pressure measurements. Design: prospective randomised comparative trial. Material and methods: three hundred and forty-four patients with 362 consecutive infrainguinal vein bypasses were prospectively randomised to a follow-up regime with or without duplex scanning (ABI group and DD group) at 1, 3, 6, 9, and 12 months postoperatively.Results: one hundred and eighty-three grafts were enrolled to the ABI group and 179 to the DD group. The primary assisted patency, secondary patency and limb salvage rates were 67%, 74%, 85% for the ABI group and 67%, 73%, 81% for the DD group. Ninety grafts in the ABI group and 57 in the DD group had surveillance that completely adhered to the protocol. The outcome was also similar for these groups at one year (77%, 87%, 94% and 77%, 83%, 93% respectively), although grafts were revised more frequently in the DD group.Conclusions: intensive surveillance with duplex scanning did not improve the results of any outcome criteria examined. To demonstrate any potential benefit of duplex scanning for vein-graft surveillance a multicentre study with a large number of patients to ensure sufficient power is needed

Angiographic Runoff Score as a Predictor of Outcome Following Femorocrural Bypass Surgery

AbstractObjective:to evaluate the efficacy of the revised ad hoc scoring system in predicting the outcome of femorocrural bypass surgery.Design:retrospective study.Materials and methods:seventy-seven infrainguinal bypass procedures to the crural arteries were performed in 69 patients with critical leg ischaemia. Preoperative angiographic findings were graded according to the revised ad hoc scoring system and other preoperative angiographic measures.Results:the revised ad hoc scores were valuable in predicting the outcome of these grafts. The status of the outflow artery throughout its length had a great impact on the long-term outcome in terms of secondary patency, leg salvage, patients alive with legs, and survival rates. In situ autogenous saphenous grafts achieved the best immediate and long-term results.Conclusions:the revised ad hoc angiographic scoring method is useful in predicting the outcome of patients undergoing femorocrural arterial reconstruction. Patients with an outflow artery completely open throughout its length had excellent long-term results