One Year Outcomes Of Transapical Tavrs With Sutures Secured Using Automated Fasteners And Rapid Pacing. A Safe Technique For Transapical Access
Roberto Rodriguez, Roi Altit, Eric Gnall, Paul Coady, Sandra Abramson, Lisa Igidbashian, Kate Hawthorne, William Gray, Scott M. Goldman.
Lankenau Medical Center, Wynnewood, PA, USA.
OBJECTIVE: To evaluate the clinical outcomes of TAVR patients followed for at least one year after trans-apical approach with prosthetic attachment sutures secured by automated titanium fasteners.
METHODS: We conducted a single-institution retrospective review of clinical outcomes for patients involved in an on-going IRB study regarding Trans-Apical TAVR approach. During the 34-month period from January 2014 to October 2016, a total of 164 Trans-Apical TAVRs were performed at our institution using automated titanium fastener technology. Echocardiographic guidance to best point of entry, two 2-O Prolene vertical mattress sutures placed under rapid ventricular pacing. The 24 Fr. sheath is removed, after TAVR placement, with rapid ventricular pacing and automated titanium fasteners. Inhospital and 1 year clinical outcomes were evaluated. Patient post-operative histories, TVT registry, physician records and follow-up studies, such as echocardiography, were analyzed.
RESULTS: Patient records from a total of 164 consecutive Trans-Apical TAVRs were reviewed. All Trans-Apical TAVRs sites were successfully closed with automated titanium fasteners. Mean age for all patients was 84. The median STS predicted risk of mortality was 7.6%. Other concomitant comorbidities included previous sternotomy 40.2%, PAD 51.2%, Diabetes 28%, Dialysis 1.2%, and home O2 6.7%. The 30-day mortality rate was 3.7%, 1-year mortality was 5.5%. 30 -day stroke rate was 1.2%. The valve in previous surgical valve procedure rate was 9.8%. Other complications included permanent pacemaker 11%, conversion to sternotomy 0.6%, vascular complications 0%, wound infection 0.6% and atrial fibrillation 7%. No adverse outcomes were attributable to the use of automated titanium fasteners. Discharge echocardiograms results: aortic insufficiency; None 36.6%, Trace 42.7%, Mild 18.3%, Moderate 2.4% and Severe 0%. The mean gradient pre TAVR was 47.3mmHg vs 8.0 mmHg post TAVR.
CONCLUSIONS: At a minimum of one-year follow-up, automated titanium fasteners appear to be safe and effective for securing ventriculotomy site after trans-apical TAVR. The use of titanium fasteners along with rapid ventricular pacing seems to be reliable technique for apical closure.
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