PMID- 21371900
OWN - NLM
STAT- MEDLINE
DCOM- 20120206
LR  - 20191210
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 39
IP  - 6
DP  - 2011 Jun
TI  - Alternative approaches for trans-catheter self-expanding aortic bioprosthetic 
      valves implantation: single-center experience.
PG  - e151-8
LID - 10.1016/j.ejcts.2011.01.014 [doi]
AB  - OBJECTIVE: Trans-catheter aortic valve implantation has emerged and rapidly 
      gained credibility as a valuable alternative to treat patients with severe aortic 
      stenosis and no surgical option; however, these patients are often affected also 
      by severe iliac-femoral arteriopathy, rendering the transfemoral approach 
      unemployable. From May 2008, 92 patients with severe, symptomatic aortic stenosis 
      and no reasonable surgical option because of excessive risk underwent 
      trans-catheter aortic valve implantation at our center. Eighty patients (34 male) 
      with mean age 82 +/- 8 years were eligible for CoreValve percutaneous femoral 
      implantation. Twelve patients, mean age 81 +/- 8 years, were excluded from 
      percutaneous femoral CoreValve implantation because of iliac-femoral 
      arteriopathy. METHODS: These 12 patients underwent trans-catheter aortic valve 
      implantation through the left axillary artery in six cases, the other six 
      directly from the ascending aorta through a right anterior mini-thoracotomy. 
      Procedures were performed by a combined team of cardiologists, cardiac surgeons, 
      and anesthetists. RESULTS: Procedural success was obtained in 11 cases; all these 
      patients were discharged in asymptomatic status, with midterm good prosthesis 
      performance. Three patients required the implantation of a permanent pacemaker. 
      One patient needed a subclavian covered stent implantation to treat a 
      post-implant artery dissection. One patient of the direct aortic access group was 
      converted to the femoral approach due to an extremely fragile aortic wall, but 
      died in the intensive care unit of abdominal aortic aneurysm rupture. All 
      discharged patients improved their New York Heart Association (NYHA) functional 
      class and functional capacity, and echocardiograms evidenced good valve 
      performance at 2 years. CONCLUSIONS: Trans-catheter aortic valve implantation 
      with surgical subclavian or direct aortic approach seems safe and feasible, 
      offering a new attractive option to treat selected high-risk patients with severe 
      aortic stenosis and peripheral vasculopathy, and has emerged as a valuable 
      alternative route to trans-apical procedures.
CI  - Copyright (c) 2011 European Association for Cardio-Thoracic Surgery. Published by 
      Elsevier B.V. All rights reserved.
FAU - Bruschi, Giuseppe
AU  - Bruschi G
AD  - Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, 
      Italy. giuseppe.bruschi@fastwebnet.it
FAU - De Marco, Federico
AU  - De Marco F
FAU - Fratto, Pasquale
AU  - Fratto P
FAU - Oreglia, Jacopo
AU  - Oreglia J
FAU - Colombo, Paola
AU  - Colombo P
FAU - Botta, Luca
AU  - Botta L
FAU - Klugmann, Silvio
AU  - Klugmann S
FAU - Martinelli, Luigi
AU  - Martinelli L
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20110302
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve/*surgery
MH  - Aortic Valve Stenosis/*surgery
MH  - Axillary Artery
MH  - *Bioprosthesis
MH  - Cardiac Catheterization/methods
MH  - Female
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures/methods
MH  - Prosthesis Design
MH  - Tomography, X-Ray Computed
EDAT- 2011/03/05 06:00
MHDA- 2012/02/07 06:00
CRDT- 2011/03/05 06:00
PHST- 2010/09/02 00:00 [received]
PHST- 2010/12/30 00:00 [revised]
PHST- 2011/01/05 00:00 [accepted]
PHST- 2011/03/05 06:00 [entrez]
PHST- 2011/03/05 06:00 [pubmed]
PHST- 2012/02/07 06:00 [medline]
AID - S1010-7940(11)00070-4 [pii]
AID - 10.1016/j.ejcts.2011.01.014 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2011 Jun;39(6):e151-8. doi: 10.1016/j.ejcts.2011.01.014. 
      Epub 2011 Mar 2.