Original Scientific Article
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Journal of Structural Heart Disease, April 2019, Volume 5, Issue 2:25-37
DOI: 10.12945/j.jshd.2019.023.18
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, UHSH Heart and Vascular Institute, Wilson Medical Center, Endicott, 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 angiography system (PAS) versus mounted angiography system (MAS) in high-risk patients with severe symptomatic 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 comparable 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 intervention (8.7% vs 5.3%, P = 0.62), pacemaker implantation (13.0 vs 6.7%, P = 0.39), rehospitalization (8.7% vs 18.7%, P = 0.35), improvement in New York Heart Association functional class (P = 0.17), and degree of paravalvular 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 modality for TAVR procedures with less total radiation exposure than MAS.
Cite this article as: Ahmed B, Ganesh P, Traverse M, Piekarski GM, Mauro KA, Niclou AM, Yarkoni A. Portable Versus Mounted Fluoroscopic Imaging During Transcatheter Aortic Valve Replacement. Structural Heart Disease 2019;5(2):25-37. DOI: 10.12945/j.jshd.2019.023.18
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Original Scientific Article
Journal of Structural Heart Disease, April 2019, Volume 5, Issue 2:25-37
DOI: 10.12945/j.jshd.2019.023.18
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, UHSH Heart and Vascular Institute, Wilson Medical Center, Endicott, 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 angiography system (PAS) versus mounted angiography system (MAS) in high-risk patients with severe symptomatic 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 comparable 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 intervention (8.7% vs 5.3%, P = 0.62), pacemaker implantation (13.0 vs 6.7%, P = 0.39), rehospitalization (8.7% vs 18.7%, P = 0.35), improvement in New York Heart Association functional class (P = 0.17), and degree of paravalvular 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 modality for TAVR procedures with less total radiation exposure than MAS.
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Cite this article as: Ahmed B, Ganesh P, Traverse M, Piekarski GM, Mauro KA, Niclou AM, Yarkoni A. Portable Versus Mounted Fluoroscopic Imaging During Transcatheter Aortic Valve Replacement. Structural Heart Disease 2019;5(2):25-37. DOI: 10.12945/j.jshd.2019.023.18
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