Influence of surgical volume on outcomes in low-risk patients undergoing isolated surgical aortic valve replacement.

Background: Intermediate- and high-risk patients undergoing isolated surgical aortic valve replacement have superior outcomes at higher-volume compared with lower-volume hospitals. This study examines the impact of hospital volume on outcomes in low-risk patients undergoing aortic valve replacement.

Methods: Using data from our 29 North Texas hospital collaborative, we examined 2066 low-risk cases (Society of Thoracic Surgeons Predicted Risk of Mortality of ≤3%) undergoing aortic valve replacement surgery between January 1, 2012, and December 31, 2017.

The safety and efficacy of temporary distal aortic occlusion to facilitate TAVR large-bore arterial closure.

Objectives: To evaluate the safety and efficacy of temporary distal aortic occlusion (TDAO) for facilitated large-bore arterial closure during transcatheter aortic valve replacement (TAVR).

Background: Ipsilateral iliac artery occlusion and TDAO have been used to facilitate TAVR delivery sheath access-site closure, but ipsilateral iliac artery occlusion has been associated with arterial complications at the balloon site.

Methods: TDAO was performed in 117 consecutive transfemoral TAVR cases from July 2010 to April 2012.

Early regression of severe left ventricular hypertrophy after transcatheter aortic valve replacement is associated with decreased hospitalizations.

Objectives: This study sought to examine the relationship between left ventricular mass (LVM) regression and clinical outcomes after transcatheter aortic valve replacement (TAVR).

Background: LVM regression after valve replacement for aortic stenosis is assumed to be a favorable effect of LV unloading, but its relationship to improved clinical outcomes is unclear.

Methods: Of 2,115 patients with symptomatic aortic stenosis at high surgical risk receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) randomized trial or continued access registry, 690 had both severe LV hypertrophy (left ventricular mass index [LVMi] ≥ 149 g/m(2) men, ≥ 122 g/m(2) women) at baseline and an LVMi measurement at 30-day post-TAVR follow-up.

Transapical aortic valve replacement for severe aortic stenosis: results from the nonrandomized continued access cohort of the PARTNER trial.

Background: Transapical (TA) aortic valve replacement was an integral part of the Placement of Transcatheter Aortic Valves (PARTNER) trial. Enrollment during the randomized trial included 104 transapical (premarket approval TA [PMA-TA]) and 92 surgical aortic valve replacements (SAVR) within the TA cohort. On completion of the trial, enrollment continued in a nonrandomized continued access (NRCA) program.

Randomized trial of surgical cutdown versus percutaneous access in transfemoral TAVR.

Objectives: To compare iliofemoral arterial complications with transfemoral transcatheter aortic valve replacement (TF-TAVR) utilizing surgical cutdown versus percutaneous access with closure devices in a randomized trial.

Background: Major vascular complications following TAVR are a significant risk of the procedure. There are no randomized data comparing whether access method in TF-TAVR influences the risk of such complications.

Transcatheter aortic-valve replacement for inoperable severe aortic stenosis.

Background: Transcatheter aortic-valve replacement (TAVR) is the recommended therapy for patients with severe aortic stenosis who are not suitable candidates for surgery. The outcomes beyond 1 year in such patients are not known.

Methods: We randomly assigned patients to transfemoral TAVR or to standard therapy (which often included balloon aortic valvuloplasty).

Health-related quality of life after transcatheter aortic valve replacement in inoperable patients with severe aortic stenosis.

Background- Transcatheter aortic valve replacement (TAVR) has been shown to improve survival compared with standard therapy in patients with severe aortic stenosis who cannot have surgery. The effects of TAVR on health-related quality of life have not been reported from a controlled study. Methods and Results- The Placement of Aortic Transcatheter Valves (PARTNER) trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgical valve replacement to TAVR (n=179) or standard therapy (n=179).

Temporary aortic occlusion to facilitate large-bore arterial closure.

Percutaneous closure of large-bore arterial sheaths remains a clinical challenge. We report a case of facilitated large-bore closure using a low-profile valvuloplasty balloon for aortic occlusion. This technique enhanced percutaneous closure device deployment and improved hemostasis during arteriotomy closure.

Method for coronary angiography in morbidly obese patients.

Cardiac catheterization in morbidly obese patients is difficult. In addition to problems regarding vascular access and radiographic penetration of the chest, the engineering parameters and physical limitations of the table and its supporting structures may limit these patients' ability to undergo clinically indicated coronary angiography. We describe a method for cardiac catheterization in which much of the obese patient's body weight is supported on a stretcher placed at right angles to the catheterization table, with only the thorax on the table under the image intensifier.