Background: The presence of severe calcific atherosclerosis at the iliofemoral axis may preclude transcatheter aortic valve implantation (TAVI) by the transfemoral (TF) approach. Intravascular lithotripsy (IVL) is a novel technology that fractures intimal/medial calcium and increases vessel compliance allowing TF TAVI in selected patients with peripheral artery disease (PAD). Aims: The aim of this study was to report on the safety and efficacy of IVL-assisted TF TAVI in an allcomers population. Methods: Clinical, imaging and procedural data on all consecutive patients treated by IVL-assisted TF TAVI in six high-volume European centres (2018-2020) were collected in this prospective, real-world, multicentre registry. Results: IVL-assisted TF TAVI was performed in 108 patients, increasing from 2.4% to 6.5% of all TAVI from 2018 to 2020, respectively. The target lesion was most often localised at the common and/or external iliac artery (93.5% of cases; average TL-MLD 4.6 +/- 0.9 mm with 318 degrees of calcium arc). Transfemoral aortic valve delivery was successful in 100% of cases; final procedural success in 98.2% (two conversions to cardiac open surgery for annular rupture and valve migration). Complications of the IVL-treated segments consisted of 1 perforation and 3 major dissections requiring stent implantation (2 covered stents and 2 BMS). Access-site-related complications included 3 major bleedings. Three in-hospital deaths were recorded (2.8%, 1 failed surgical conversion after annular rupture, 1 cardiac arrest after initial valvuloplasty,

Peripheral intravascular lithotripsy for transcatheter aortic valve implantation: a multicentre observational study / Nardi, Giulia; De Backer, Ole; Saia, Francesco; Søndergaard, Lars; Ristalli, Francesca; Meucci, Francesco; Stolcova, Miroslava; Mattesini, Alessio; Demola, Pierluigi; Wang, Xi; Al Jabri, Anees; Palmerini, Tullio; Bruno, Antonio Giulio; Ielasi, Alfonso; Van Belle, Eric; Berti, Sergio; di Mario, Carlo. - In: EUROINTERVENTION. - ISSN 1774-024X. - STAMPA. - 17:(2022), pp. 1397-1406. [10.4244/EIJ-D-21-00581]

Peripheral intravascular lithotripsy for transcatheter aortic valve implantation: a multicentre observational study

Nardi, Giulia;Ristalli, Francesca;Stolcova, Miroslava;Mattesini, Alessio;Demola, Pierluigi;di Mario, Carlo
2022

Abstract

Background: The presence of severe calcific atherosclerosis at the iliofemoral axis may preclude transcatheter aortic valve implantation (TAVI) by the transfemoral (TF) approach. Intravascular lithotripsy (IVL) is a novel technology that fractures intimal/medial calcium and increases vessel compliance allowing TF TAVI in selected patients with peripheral artery disease (PAD). Aims: The aim of this study was to report on the safety and efficacy of IVL-assisted TF TAVI in an allcomers population. Methods: Clinical, imaging and procedural data on all consecutive patients treated by IVL-assisted TF TAVI in six high-volume European centres (2018-2020) were collected in this prospective, real-world, multicentre registry. Results: IVL-assisted TF TAVI was performed in 108 patients, increasing from 2.4% to 6.5% of all TAVI from 2018 to 2020, respectively. The target lesion was most often localised at the common and/or external iliac artery (93.5% of cases; average TL-MLD 4.6 +/- 0.9 mm with 318 degrees of calcium arc). Transfemoral aortic valve delivery was successful in 100% of cases; final procedural success in 98.2% (two conversions to cardiac open surgery for annular rupture and valve migration). Complications of the IVL-treated segments consisted of 1 perforation and 3 major dissections requiring stent implantation (2 covered stents and 2 BMS). Access-site-related complications included 3 major bleedings. Three in-hospital deaths were recorded (2.8%, 1 failed surgical conversion after annular rupture, 1 cardiac arrest after initial valvuloplasty,
2022
17
1397
1406
Nardi, Giulia; De Backer, Ole; Saia, Francesco; Søndergaard, Lars; Ristalli, Francesca; Meucci, Francesco; Stolcova, Miroslava; Mattesini, Alessio; Demola, Pierluigi; Wang, Xi; Al Jabri, Anees; Palmerini, Tullio; Bruno, Antonio Giulio; Ielasi, Alfonso; Van Belle, Eric; Berti, Sergio; di Mario, Carlo
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1307499
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