Transcaval Access For TAVR in High-Risk Patients

Transcaval access may enable patients who are not good candidates for transthoracic access to undergo transcatheter aortic valve replacement (TAVR), according to the results of the Transcaval TAVR Trial presented at TCT 2016 and simultaneously published in the Journal of the American College of Cardiology.

Adam B. Greenbaum, MD, FACC, et al., assessed the outcomes of percutaneous TAVR via transcaval access in 100 patients who were ineligible for femoral artery access or at high risk of complications from transthoracic access. Researchers examined pre-discharge and 30-day abdominal CT.

The results of the study showed that transcaval access enabled TAVR in the high-risk patient group. Transcaval access was successful in 99 out of 100 patients, with device success reached in 98 out of 99. The in-patient survival rate was 96 percent, while the 30-day survival was 92 percent. The average length of hospital stay was 4 days. The authors note that ““bleeding and vascular complications, using permeable nitinol cardiac occluders to close the access ports, were common but acceptable in this high risk cohort.”

They add that, “transcaval access should be investigated in patients who are eligible for transthoracic access. Purpose-built closure devices are in development that may simplify the procedure and reduce bleeding.”

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Transcatheter Cardiovascular Therapeutics, Aortic Valve Stenosis, Cardiac Surgical Procedures, Heart Valve Diseases, Registries, Transcatheter Aortic Valve Replacement

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