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Related Concept Videos

Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

36
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
42

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Transcaval Transcatheter Aortic Valve Replacement: Clinical Outcomes From a TAVI Program Without Prior Transcaval

Conor J Doyle1, Brian McGrath1, Ronan Margey1

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Transcatheter aortic valve implantation (TAVI) via the transcaval (TCv) route is a viable option for patients with challenging anatomy. This study demonstrates high procedural success and low mortality for TCv TAVI, even at centers new to the technique.

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Area of Science:

  • Cardiovascular Interventions
  • Structural Heart Disease
  • Vascular Access

Background:

  • Transcatheter aortic valve implantation (TAVI) is a crucial treatment for aortic stenosis.
  • The transcaval (TCv) access route offers an alternative for patients with hostile iliofemoral anatomy.
  • Limited data exists on TCv TAVI outcomes, with fewer than 500 published cases.

Purpose of the Study:

  • To evaluate the procedural and clinical outcomes of TCv TAVI.
  • To assess the feasibility of TCv TAVI at a center without prior experience.
  • To contribute to the limited body of evidence for this TAVI access route.

Main Methods:

  • A prospective TAVI database was utilized to identify patients undergoing TCv TAVI.
  • Baseline clinical and procedural data were collected.
  • Outcomes were assessed using Valve Academic Research Consortium (VARC) standardized endpoints.

Main Results:

  • Twenty-one patients underwent TCv TAVI between February 2020 and July 2024.
  • Technical success was 100%, and clinical success was 95%, with 0% stroke/death at 30 days.
  • One-year survival was 89.6%, with low rates of major complications.

Conclusions:

  • TCv TAVI can be performed with high procedural success and low risk of mortality and stroke.
  • Experienced operators with appropriate training and imaging support are key.
  • This approach is a valuable option for TAVI in complex iliofemoral anatomies.