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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Feasibility and outcomes of combined transcatheter aortic valve replacement with other structural heart interventions

Ahmed A Khattab1, Steffen Gloekler1, Beate Sprecher1

  • 1Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland.

Open Heart
|October 22, 2014
PubMed

Insights

Single-session transcatheter aortic valve implantation (TAVI) combined with other cardiac interventions is feasible in elderly patients. This approach shows comparable safety outcomes to TAVI alone, despite longer procedure times.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Cardiology

Background:

  • Concurrent cardiac diseases are common in elderly patients, necessitating simultaneous treatment for optimal outcomes.
  • Transcatheter aortic valve implantation (TAVI) has become a standard treatment for aortic stenosis in elderly patients.

Purpose of the Study:

  • To evaluate the feasibility of performing combined single-session percutaneous cardiac interventions alongside TAVI.
  • To assess the safety and efficacy of combined procedures compared to TAVI alone.

Main Methods:

  • A prospective, case-control study involving 10 patients undergoing combined TAVI, left atrial appendage occlusion, and percutaneous coronary interventions in a single session.
  • Patients also underwent patent foramen ovale or atrial septal defect closure if indicated.
  • A 1:10 matching with TAVI-only controls was performed based on baseline characteristics.
  • Outcomes were assessed using Valve Academic Research Consortium (VARC) criteria.

Main Results:

  • Combined interventions required longer procedural times, increased radiation exposure, and higher contrast dye usage compared to TAVI alone.
  • Despite increased procedural demands, there was no significant difference in VARC-defined safety endpoints during hospitalization and at 30-day follow-up.
  • The combined intervention group showed a trend towards better safety outcomes (20% vs 32% VARC combined safety endpoint).

Conclusions:

  • Single-session transcatheter treatment of concurrent cardiac diseases, including TAVI, is feasible in high-volume centers with experienced operators.
  • This approach offers a safe alternative for elderly patients requiring multiple cardiac interventions simultaneously.
  • Combined procedures can be performed without compromising safety outcomes compared to TAVI alone.
Abstract

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