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Journal of Cardiothoracic Surgery
Published in: Journal of Cardiothoracic Surgery 1/2023

Open Access 01-12-2023 | Abdominal Aortic Aneurysm | Case Report

Percutaneous treatment of abdominal aortic aneurysm and aortic valve stenosis with ‘staged’ EVAR and TAVR: a case series

Authors: Massimo Medda, Francesco Casilli, Marta Bande, Mattia Glauber, Maurizio Tespili, Silvia Cirri, Francesco Donatelli

Published in: Journal of Cardiothoracic Surgery | Issue 1/2023

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Abstract

Symptomatic aortic valve stenosis (AS) and abdominal aortic aneurysm (AAA) are critical clinical conditions, increasingly more prevalent with aging of the population. Calcific aortic stenosis is the most common structural cardiac disease in the elderly population, and medical management of severe aortic stenosis of the elderly population is associated with poor outcomes as compared to surgical treatment. Transcatheter aortic valve replacement (TAVR) is a treatment of choice in inoperable, often elderly, patients with symptomatic severe AS and in intermediate-to-high surgical risk patients. It is not yet clarified the incidence of AAA and its impact on procedural and clinical outcomes among patients undergoing TAVR. It is known that after AS resolution with aortic valve replacement or TAVR there is an increase in blood pressure that increases the risk of dissection or abdominal aortic aneurysm rupture if AAA repair is delayed. The purpose of this report is to describe the anatomical details and technical and procedural considerations when proposing totally endovascular strategies dedicated to the treatment of patients with AS and AAA.
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Literature
1.
Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607.CrossRefPubMed
2.
Adams DH, Popma JJ, Reardon JM, et al. Transcatheter aortic valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370:1790–8.CrossRefPubMed
3.
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–11.CrossRefPubMed
4.
Kurra V, Schoenhagen P, Roselli EE, Kapadia SR, Tuzcu EM, Greenberg R, et al. Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: preprocedural assessment with multidetector computed tomography. J Thorac Cardiovasc Surg. 2009;137(5):1258–64.CrossRefPubMed
5.
Arsalan M, Szerlip M, Vemulapalli S, Holper EM, Arnold SV, Li Z, DiMaio MJ, Rumsfeld JS, Brown DL, Mack MJ. Should transcatheter aortic valve replacement be performed in nonagenarians?: Insights from the STS/ACC TVT registry. J Am Coll Cardiol. 2016;67(12):1387–95.CrossRefPubMedPubMedCentral
6.
Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.CrossRefPubMed
7.
Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for trans- catheter aortic valve implantation: the valve academic research consortium-2 consensus document (VARC2). Eur J Cardiothorac Surg. 2012;42:S45–60.CrossRefPubMed
8.
Lioupis C, Medda M, Inglese L. Thoracic aneurysm repair: managing severe tortuosity with brachiofemoral traction. Catheter Cardiovasc Interv. 2007;70:1041–5.CrossRefPubMed
9.
Medda M, Casilli F, Bande M, Miceli A, Messina F, Glauber M, Tespili M. First case report of a severe stent frame infolding of a self-expanding transcatheter aortic valve (CoreValve Evolut R 34 mm) in a complex patient with calcific bicuspid aortic valve stenosis. Cardiovasc Revasc Med. 2020;21(9):1189–90.CrossRefPubMed
10.
Sievers HH, Schmidtke C. A Classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovac Surg. 2007;133:1226–33.CrossRef
11.
Thourani VH, Myung R, Kilgo P, Thompson K, Puskas JD, Lattouf OM, et al. Long-term outcomes after isolated aortic valve replacement in octogenarians: a modern perspective. Ann Thorac Surg. 2008;86:1458–64.CrossRefPubMed
12.
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021;143(5):e72–227.PubMed
13.
Brewster DC, Cronenwett JL, Hallett JW, Johnston KW, Krupski WC, Matsumura JS, et al. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the joint council of the American Association for vascular surgery and society for vascular surgery. J Vasc Surg. 2003;37:1106–17.CrossRefPubMed
14.
Lederle FA, Johnson GR, Wilson SE, Ballard DJ, Jordan WD Jr, Blebea J, et al. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002;287:2968–72.CrossRefPubMed
15.
Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351:1607–18.CrossRefPubMed
16.
Goueffic Y, Becquemin JP, Desgranges P, Kobeiter H. Midterm survival after endovascular versus open repair of infrarenal aortic aneurysms. J Endovasc Ther. 2005;12:47–57.CrossRefPubMed
17.
Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG, EVAR trial Participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364:843–8.CrossRefPubMed
18.
Davis M, Taylor P. Endovascular infrarenal abdominal aortic aneurysm repair. Heart. 2008;94(2):222–8.CrossRefPubMed
19.
Lim S, Halandras PM, Park T, Lee Y, Crisostomo P, Hershberger R, et al. Outcomes of endovascular abdominal aortic aneurysm repair in high-risk patients. J Vasc Surg. 2015;61(4):862–8.CrossRefPubMed
20.
Kobayashia A, Lazkania M, Mouallaa S, Oraziob A, Tassetb M, Morrisc M, Fangb K, Pershada A. Impact of aortic aneurysms in trans-catheter aortic valve replacement: a single center experience. Indian Heart J. 2018;70:S303–8.CrossRef
21.
Kurra V, Schoenhagen P, Roselli EE, Kapadia SR, Tuzcu EM, Greenberg R, et al. Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: preprocedural assessment with multidetector computed tomography. J Thorac Cardiovasc Surg. 2009;137:1258–64.CrossRefPubMed
22.
Kordowicz A, Ghosh J, Baguneid M. A single centre experience of simultaneous open abdominal aortic aneurysm and cardiac surgery. Interact Cardiovasc Thorac Surg. 2010;10(1):63–61.CrossRefPubMed
23.
Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609–20.CrossRefPubMed
24.
Attia RR, Murphy JD, Snider M, Lappas DG, Darling C, Lowenstein E. Myocardial ischemia due to infrarenal aortic cross-clamping during aortic surgery in patients with severe coronary artery disease. Circulation. 1976;53:961–4.CrossRefPubMed
25.
Gooding JM, Archie JP, McDowell H. Hemodynamic response to infrarenal aortic cross-clamping in patients with and without coronary artery disease. Crit Care Med. 1980;8:382–5.CrossRefPubMed
26.
Durham SJ, Steed DL, Moosa HH, Makaroun MS, Webster MW. Probability of rupture of an abdominal aortic aneurysm after an unrelated operative procedure: a prospective study. J Vasc Surg. 1991;13:248–52.CrossRefPubMed
27.
Thompson RW, Parks WC. Role of matrix metalloproteinases in abdominal aortic aneurysms. Ann NY Acad Sci. 1996;800:157–74.CrossRefPubMed
28.
Orejola WC, Elmann EM, Wilderman MJ, Cocke TP, Vaidya P, Simonian GT. Combined transcatheter aortic valve replacement and endovascular aortic repair: a transfemoral approach dilemma. J Surg. 2016;4:1.
29.
Koudoumas D, Iyer V, Curl RG. Simultaneous percutaneous transcatheter aortic valve replacement and endovascular abdominal aortic aneurysm repair in a high risk patient with hostile aortic neck, a case report. J Cardiothorac Surg. 2015;10:184.CrossRefPubMedPubMedCentral
30.
Aziz F, Kozak M, Pae WE. Combined transfemoral aortic valve replacement and endovascular repair of abdominal aortic aneurysm in nonagenarians is feasible. Clin Surg. 2016;1:1153.
31.
Schizas N, Antonopoulos CN, Patris V, Lampropoulos K, Kratimenos T, Argiriou M. Current issues on simultaneous TAVR (transcatheter aortic valve replacement) and EVAR (endovascular aneurysm repair). Clin Case Rep. 2021;9:e03929.CrossRef
32.
Drury-Smith M, Garnham A, Khogali S. Sequential trans-catheter aortic valve implantation and abdominal aortic aneurysm repair. Catheter Cardiovasc Interv. 2012;79:784–8.CrossRefPubMed
33.
Ayhan H, Durmaz T, Keles T, et al. Simultaneously successful transfemoral aortic valve implantation and endovascular repair of thoracic aortic saccular aneurysm. Int Heart J. 2014;55:459–62.CrossRefPubMed
34.
Kawashima H, Watanabe Y, Kozuma K. Successful transfemoral aortic valve implantation through aortic stent graft after endovascular repair of abdominal aortic aneurysm. Cardiovasc Interv Ther. 2017;32(2):165–9.CrossRefPubMed
Metadata
Title
Percutaneous treatment of abdominal aortic aneurysm and aortic valve stenosis with ‘staged’ EVAR and TAVR: a case series
Authors
Massimo Medda
Francesco Casilli
Marta Bande
Mattia Glauber
Maurizio Tespili
Silvia Cirri
Francesco Donatelli
Publication date
01-12-2023

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