Abstract 16627: Predicting Vascular Complications in Transcatheter Aortic Valve Replacement (TAVR) Using Computed Tomography Angiography (CTA)
Background: Vascular complications are frequent during trans-femoral (TF)-TAVR. 3D CTA may provide a more thorough assessment of the vasculature than 2D angiography for patient selection.
Methods: Clinical and CT angiography data were obtained from the electronic medical record and analysis of individual patient CTA’s, respectively. Vascular complications were defined per the Valvular Academic Research Consortium-2 recommendations. Sheath:femoral artery ratio (SFAR) and sheath:femoral artery area ratio (SFAAR) were defined as the ratio of the sheath outer diameter to the femoral minimal lumen diameter (MLD) and sheath area to the femoral minimal lumen area (MLA), respectively.
Results: Of 255 patients undergoing TF-TAVR, vascular complications occurred in 28 (11%) patients. Mean SFAR was 1.39 ± 0.31 and mean SFAAR was 1.36 ± 0.59. Multivariate modeling demonstrated that SFAR [OR (95% CI): 8.3(1.8-39.1)] and log-transformed SFAAR [OR(95% CI): 40.1 (2.4-650.0)] were significant predictors of vascular complications in discrete regression analysis. Using receiver operating characteristic curve analysis, we determined a SFAAR threshold of 1.35 to predict the occurrence of vascular complications with greater sensitivity (78.6%) than the SFAR threshold of 1.45 (sensitivity =64.2%). (Figure 1)
Conclusions: SFAR and SFAAR determined using CT angiography were significant predictors of vascular complications among patients undergoing TF-TAVR. Utilization of CTA-based area indices (SFAAR) may provide a more accurate screen for patients undergoing evaluation for TF-TAVR, as this takes into consideration the elliptical nature of the vessel.
- Aortic stenosis
- Transcatheter Aortic Valve Implantation
- Cardiovascular imaging
- Valvular heart disease
- Aortic valve
- © 2013 by American Heart Association, Inc.