Transapical aortic valve implantation without angiography: proof of concept.

Détails

ID Serval
serval:BIB_5DBFF2D45C54
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Transapical aortic valve implantation without angiography: proof of concept.
Périodique
Annals of Thoracic Surgery
Auteur⸱e⸱s
Ferrari Enrico, Sulzer Christopher, Marcucci Carlo, Rizzo Elena, Tozzi Piergiorgio, von Segesser Ludwig K.
ISSN
1552-6259[electronic], 0003-4975[linking]
Statut éditorial
Publié
Date de publication
2010
Volume
89
Numéro
6
Pages
1925-1932
Langue
anglais
Résumé
Background:
Cardiac computed tomographic scans, coronary angiograms, and aortographies are routinely performed in transcatheter heart valve therapies. Consequently, all patients are exposed to multiple contrast injections with a following risk of nephrotoxicity and postoperative renal failure. The transapical aortic valve implantation without angiography can prevent contrast-related complications.
Methods:
Between November 2008 and November 2009, 30 consecutive high-risk patients (16 female, 53.3%) underwent transapical aortic valve implantation without angiography. The landmarks identification, the stent-valve positioning, and the postoperative control were routinely performed under transesophageal echocardiogram and fluoroscopic visualization without contrast injections.
Results:
Mean age was 80.1 +/- 8.7 years. Mean valve gradient, aortic orifice area, and ejection fraction were 60.3 +/- 20.9 mm Hg, 0.7 +/- 0.16 cm(2), and 0.526 +/- 0.128, respectively. Risk factors were pulmonary hypertension (60%), peripheral vascular disease (70%), chronic pulmonary disease (50%), previous cardiac surgery (13.3%), and chronic renal insufficiency (40%) (mean blood creatinine and urea levels: 96.8 +/- 54 mu g/dL and 8.45 +/- 5.15 mmol/L). Average European System for Cardiac Operative Risk Evaluation was 32.2 +/- 13.3%. Valve deployment in the ideal landing zone was 96.7% successful and valve embolization occurred once. Thirty-day mortality was 10% (3 patients). Causes of death were the following: intraoperative ventricular rupture (conversion to sternotomy), right ventricular failure, and bilateral pneumonia. Stroke occurred in one patient at postoperative day 9. Renal failure (postoperative mean blood creatinine and urea levels: 91.1 +/- 66.8 mu g/dL and 7.27 +/- 3.45 mmol/L), myocardial infarction, and atrioventricular block were not detected.
Conclusions:
Transapical aortic valve implantation without angiography requires a short learning curve and can be performed routinely by experienced teams. Our report confirms that this procedure is feasible and safe, and provides good results with low incidence of postoperative renal disorders. (Ann Thorac Surg 2010; 89: 1925-33) (C) 2010 by The Society of Thoracic Surgeons
Mots-clé
Acute Kidney Injury, Induced Nephropathy, Contrast Exposure, Risk, Interventions, Mortality, Stenosis
Pubmed
Web of science
Création de la notice
08/06/2010 15:36
Dernière modification de la notice
20/08/2019 14:15
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