Abstract 19273: Impact of Sheath-Femoral Artery Diameter Ratio on Predicting Vascular Complications in Femoral Transcatheter Aortic Valve Implantation
Purpose: To elucidate risk factors (RF) which predict vascular complication of percutaneous femoral artery (FA) closure for transcatheter aortic valve implantation (TAVI).
Method: Eighty-five consecutive transfemoral (TF) TAVI patients underwent percutaneous FA closure by Prostar XL device between March 2008 and May 2010 at our institution. The ilio-femoral angiogram was done before insertion and after removal of the sheath by contralateral approach. Access site complication was defined as requirement of any rescue interventional procedures (manual compression >15 min, ballooning, stenting and surgical repair). Femoral access risk ratio (FARR) was defined as sheath size (Fr)/ minimal FA diameter (mm).
Results: Patients were 83.6±5.7 years old, logistic Euroscore 25.3±11.0 %. Edwards valve was used in 63 cases (24 Fr in 20.7%, 22 Fr 26.4% and 18–19 Fr 51.8%) and Corevalve in 22 (18 Fr in 100%). Minimal FA size was 8.32±1.21mm, tortuosity score 0.90±0.76 (0–3) and calcium score 0.87±0.79 (0–3). The sheath size was 20.5±2.5 Fr and FARR was 2.50±0.32. Access site complication occurred in 15.3% of cases, femoral perforation 9.0%, dissection 5.9%, significant femoral stenosis/occlusion 7.1%. There was no infection. By multivariate analysis the only predictor of femoral perforation (p=0.021) and access site complication (p=0.038) was the FARR. The sensitivity and specificity curves identified optimal thresholds of FARR to predict events, 2.6 for access site complication and 2.7 for femoral perforation. With these cutoff points, sensitivity, specificity, positive predictive value and negative predictive value were 57.1%, 67.1%, 25.0% and 89.1% for procedural failure, and 62.5%, 78.5%, 22.7% and 95.4% for femoral perforation, respectively.
Conclusions: FARR is the only predictor of access site complications of TF-TAVI using percutaneous approach. This new criterion should help patient selection for percutaneous approach.
- © 2010 by American Heart Association, Inc.