Abstract 4376: Puncture Site Outcome in Patients With Aortic Stenosis Treated With Percutaneous Aortic Valve Implantation
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has been shown to be an effective treatment in elderly patients with aortic stenosis. Surgical or percutaneous vascular access, allows for transfer of large devices to the aortic valve. This study examines femoral puncture site outcomes of the puncture after percutaneous aortic valve implantation.
METHODS: From April 2008 to June 2009 we prospectively studied 35 consecutive patients who underwent TAVI (CoreValve). Mean age was 77±4 years and the Euroscore was 10±8%. Femoral puncture proximal to bifurcations was performed under contralateral angiography guidance. A single Prostar XL device (10F) was then introduced through the puncture for implant suture. Then, an 18 F cannula was inserted for valve implantation. At the end of the procedure, the sutures were tied, after removing the sheath. An immediate femoral angiography throught a catheter introduced in the contralateral artery was performed to assess the final vessel appearance and to quantify luminal measurements.
RESULTS. All valves were successfully implanted. Two patients died in hospital (5.7 %). Nine patients (26%) developed advanced A-V block requiring a definitive pacemaker. Peak gradient decreased from 82±24.mmHg to 5±6 mmHg; p<0.0001. No patient developed significant aortic regurgitation. Femoral puncture site was successfully closed in 34 patients (97%) in 1 patient (3%) active bleeding at the punture site was angiographically observed, requiring a covered stent from the contralateral access. Final quantitative measurements showed no or mild residual stenosis at the suture line (mean 30±25%). No ischemic events or retroperitoneal bleeding were observed. One patient (3%) developed infection and pseudoaneurysm at the puncture site requiring surgical repair. After a mean follow-up of 8±4 months, 1 patient died from a non cardiac cause. None of the remaining patients developed claudication. No significant gradients were detected by Doppler study of the puncture site.
CONCLUSIONS. A single pre-loaded suture closure of a femoral artery puncture is a safe, feasible method for hemostasis after percutaneous aortic valve implantation, with a low incidence of early and mid-term complications related to the site access.