Page 12 - Journal of Structural Heart Disease Volume 5, Issue 2

Original Scientific Article
Journal of Structural Heart Disease, April 2019, Volume 5, Issue 2:25-37
DOI: https://doi.org/10.12945/j.jshd.2019.023.18
Received: June 24, 2018 Accepted: July 21, 2018 Published online: April 2019
Portable Versus Mounted Fluoroscopic Imaging During Transcatheter Aortic Valve Replacement
Bilal Ahmed, MD1*, Pranava Ganesh, MD1, Michele Traverse, NP1, Gina M. Piekarski, MS2, Krista A. Mauro, MS2, Alexandra M. Niclou, MS2, Alon Yarkoni, MD1
1 Department of Cardiology, UHS Heart and Vascular Institute, Wilson Medical Center, Johnson City, New York, USA 2 Department of Anthropology, Binghamton University, State University of New York, Binghamton, New York, USA
Abstract
Objectives: To compare outcomes of portable angi- ography system (PAS) versus mounted angiography system (MAS) in high-risk patients with severe symp- tomatic aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
Background: MAS is the preferred imaging modality for TAVR procedures. The role and safety of PAS have not been systematically studied in TAVR.
Methods: A retrospective study was conducted on 101 consecutive TAVR cases performed at our center from December 2014 to November 2016. Procedural, safety and clinical endpoints were compared at 30 days and 1 year.
Results: 24 patients were in the PAS group and 77 in the MAS group. There was no significant difference in all-cause mortality between the PAS and MAS group at 30 days (4.2% vs 2.6%, P = 0.56) or at 1 year (21.7% vs 16.0%, P = 0.54). The two study groups had compara- ble rates of ischemic stroke (PAS, 4.3% vs MAS, 1.3%, P = 0.42), life-threatening or major bleeding (16.7% vs 6.6%, P = 0.21), vascular complication requiring inter- vention (8.7% vs 5.3%, P = 0.62), pacemaker implanta- tion (13.0 vs 6.7%, P = 0.39), rehospitalization (8.7% vs 18.7%, P = 0.35), improvement in New York Heart Asso- ciation functional class (P = 0.17), and degree of para- valvular leak (P = 0.22). The PAS group more frequently underwent alternative vascular access (25.0% vs 1.3%, P = 0.001), which was associated with longer length of stay from procedure to discharge (3 days vs 2 days, P = 0.003). Total radiation exposure was significantly less
in the PAS group (air kerma 371 mGy vs 683 mGy, P = 0.043).
Conclusions: PAS is a safe and effective imaging modal- ity for TAVR procedures with less total radiation expo- sure than MAS.
Copyright © 2019 Science International Corp.
Key Words
Aortic stenosis • Transcatheter aortic valve replacement • Fluoroscopy • Mobile C-arm • Air kerma
Introduction
Transcatheter aortic valve replacement (TAVR) is preferred over surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic stenosis (AS) who are high-risk surgical candidates [1-6]. In this cohort of patients, large, multicenter, randomized clinical trials have demonstrated the non-inferiority of TAVR to SAVR for mortality and major cardiovascular and cerebrovascular adverse outcomes, as well as its superiority for major bleed- ing events [1-4, 7-9]. More recently, in intermediate surgical risk patients, several studies have shown the superiority of TAVR compared to SAVR for mortality, stroke, and moderate or severe aortic regurgitation at 1 year [10-13]. As a result of these investigations, TAVR is now a class IIa recommendation in patients
* Corresponding Author:
Bilal Ahmed, MD
Department of Cardiology
UHS Heart and Vascular Institute, Wilson Medical Center 30 Harrison Street, Johnson City, NY 13790, USA
Tel. +1 607 341 2615; Fax: +1 607 763 6782; E-Mail: Bilal_ahmed@uhs.org
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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