TY - JOUR

T1 - Peripheral intravascular lithotripsy for transcatheter aortic valve implantation

T2 - a multicentre observational study

AU - Nardi, Giulia

AU - De Backer, Ole

AU - Saia, Francesco

AU - Søndergaard, Lars

AU - Ristalli, Francesca

AU - Meucci, Francesco

AU - Stolcova, Miroslava

AU - Mattesini, Alessio

AU - Demola, Pierluigi

AU - Wang, Xi

AU - Al Jabri, Anees

AU - Palmerini, Tullio

AU - Bruno, Antonio Giulio

AU - Ielasi, Alfonso

AU - Van Belle, Eric

AU - Berti, Sergio

AU - Di Mario, Carlo

N1 - Publisher Copyright: © Europa Digital & Publishing 2022. All rights reserved. SU

PY - 2022

Y1 - 2022

N2 - 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 all-comers 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, 1 late hyperkalaemia in renal dysfunction). Conclusions: IVL-assisted TF TAVI proved to be a safe and effective approach, which helps to expand the indications for TF TAVI in patients with severe calcific PAD. However, these patients continue to have a higher-than-average incidence of periprocedural complications.

AB - 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 all-comers 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, 1 late hyperkalaemia in renal dysfunction). Conclusions: IVL-assisted TF TAVI proved to be a safe and effective approach, which helps to expand the indications for TF TAVI in patients with severe calcific PAD. However, these patients continue to have a higher-than-average incidence of periprocedural complications.

KW - aortic stenosis

KW - femoral

KW - TAVI

U2 - 10.4244/EIJ-D-21-00581

DO - 10.4244/EIJ-D-21-00581

M3 - Journal article

C2 - 34734559

AN - SCOPUS:85128159899

VL - 17

SP - E1397-E1406

JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

IS - 17

ER -