TY  - BOOK
AU  - Rogers, Toby
AU  - Thourani, Vinod H
TI  - The Fate of Transcaval Access Tracts: 12-Month Results of the Prospective NHLBI Transcaval Transcatheter Aortic Valve Replacement Study
SN  - 1936-8798
PY  - 2019///
KW  - *Aortic Valve/su [Surgery]
KW  - *Catheterization, Peripheral/mt [Methods]
KW  - *Transcatheter Aortic Valve Replacement
KW  - *Vena Cava, Inferior
KW  - Aged
KW  - Aged, 80 and over
KW  - Alloys
KW  - Aortic Valve/dg [Diagnostic Imaging]
KW  - Aortic Valve/pp [Physiopathology]
KW  - Catheterization, Peripheral/ae [Adverse Effects]
KW  - Equipment Design
KW  - Feasibility Studies
KW  - Female
KW  - Humans
KW  - Male
KW  - Prospective Studies
KW  - Punctures
KW  - Time Factors
KW  - Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
KW  - Transcatheter Aortic Valve Replacement/is [Instrumentation]
KW  - Transcatheter Aortic Valve Replacement/mo [Mortality]
KW  - Treatment Outcome
KW  - Vascular Closure Devices
KW  - Vascular System Injuries/et [Etiology]
KW  - Vena Cava, Inferior/dg [Diagnostic Imaging]
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online through MWHC library: 2008 - present
N2  - BACKGROUND: Transcaval access is a fully percutaneous nonfemoral artery route for TAVR. The intermediate-term fate of transcaval access tracts is not known; CONCLUSIONS: Results are reassuring 1 year after transcaval TAVR and closure using permeable nitinol occluders off-label. There were no late major vascular complications. CT demonstrated spontaneous closure of almost all fistulas. Results may be different in a lower-risk cohort, with increased operator experience, and using a dedicated transcaval closure device. (Transcaval Access for Transcatheter Aortic Valve Replacement in People With No Good Options for Aortic Access; NCT02280824); Copyright Published by Elsevier Inc; METHODS: The authors performed a prospective, multicenter, independently adjudicated trial of transcaval access, using Amplatzer nitinol cardiac occluders (Abbott Vascular, Minneapolis, Minnesota), among subjects without traditional transthoracic (transapical or transaortic) access options. One-year clinical follow-up included core laboratory analysis of serial abdominal computed tomography (CT); OBJECTIVES: The authors investigated 1-year outcomes after transcaval access and closure for transcatheter aortic valve replacement (TAVR), using commercially available nitinol cardiac occluders off-label; RESULTS: 100 subjects were enrolled. Twelve-month mortality was 29%. After discharge, there were no vascular complications of transcaval access. Among 83 evaluable CT scans after 12 months, 77 of fistulas (93%) were proven occluded, and only 1 was proven patent. Fistula patency was not associated with overall survival (p = 0.37), nor with heart failure admissions (15% if patent vs. 23% if occluded; p = 0.30). There were no cases of occluder fracture or migration or visceral injury
UR  - https://dx.doi.org/10.1016/j.jcin.2018.11.035
ER  -