Abstract 21310: Access Site Complications After Transarterial Aortic Valve Implantation Using the Medtronic CoreValve ReValving System: Impact of Short-Term Mortality
Symptomatic aortic valve stenosis in older patients (pts) — who are considered to be at higher risk for conventional aortic valve replacement due to their co-morbidities — is more frequently treated by transcatheter aortic valve implantation (TAVI). Despite of the small profile of the system, this minimally invasive strategy might bear the risk of vascular access site complications. Therefore, it was the aim of the present analysis was to elucidate the impact of access site complications on short term outcome after TAVI.
Methods/Results: Pts with significant aortic stenosis who were treated with the Medtronic CoreValve System (MCS) transarterially were analyzed. Vascular access site complications were defined as vessel dissection, perforation, occlusion, malfunction of the closure device and any other vascular complication requiring surgery or interventional therapy. A total of 325 pts (age 81±6 years; Logistic EuroSCORE 23.6±13.8%) were treated with the MCS between 2006 and 2010 at our institution. The size of the delivery system was 18 F in all cases and the axillary/subclavian artery was used as access site in seven cases (2 %), all other patients were treated transfemorally. A total of 68 pts (20.9%) had an access site complication requiring intervention. Of these patients, 19 (5.8%) experienced a vessel dissection of whom 17 were treated by stenting. Ten patients (3.1 %) had a vessel perforation; six were managed by placement of a covered stent and four required surgical reconstruction of the vessel. In 34 pts surgical access site closure had to be performed because of closure device failure (10.5%). Pts with vascular complications had a significantly higher 30-day-mortality compared to those pts who did not experience such a complication (23.5% vs. 8.9%, p=0.001).
Conclusions: Older patients with comorbidities requiring aortic valve surgery can be alternatively treated by TAVI. However, the occurrence of access site complications is associated with a higher mortality. Therefore, careful preinterventional access site screening and immediate management of vascular complications are important strategies to reduce mortality and morbidity after TAVI.
- © 2010 by American Heart Association, Inc.