Abstract 14666: Pseudoaneurysms after TAVI Using the Prostar-XL system, a Comparison Corevalve and the Edwards Sapien XT Valve
Background: Transfemoral aortic valve implantation (TAVI) requires large bore catheters. Access site and vascular complications, therefore are of concern. Beside major vascular complications, post-TAVI pseudoaneurysm formation (PAF) is a frequent minor vascular complication.
Hypothesis: The aim of the study was to compare the incidence of post-TAVI PAF between the CoreValve (CV) using the St.Jude 18-F-sheath and the Edwards Sapien XT valve (ESV) using the 16-20 F Esheath.
Methods: Between April 2010 and December 2013, 448 pts (age 81.2 ± 0.4 years) with high surgical risk (Euroscore 24.3 ± 0.8%) underwent successfully TAVI in local anesthesia using either the CV (23,26,29,31mm) or the ESV (23, 26, 29mm). Closure of the access site was perfomed in all pts by using the ProStar XL 10 suture device. All TAVI pts (357 CV and 91 ESV) were examined serially the first 5 days (day 1-3 and 5 post-TAVI) after the procedure by ultrasound (US) for clinically silent vascular complications. In case of PAF, ultrasound-guided manual compression was done followed by compression bandage for another 24 h.
Results: In 26 pts (5.6%) we observed major vascular complication after TAVI (19 [5.3 %] after CV and 7 [7.7%] after ESV, p=0.261). Seven of these 26 pts (26.9%) had to be treated surgically.
In 78 pts (17.4%) we observed post-TAVI PAF, which occurred significantly more frequently after implantation of the ESV than after implantation of the CV (19/91 [33.0%] versus 59/357 [16.6%], p=0.01). However in total only 5 /78 (6.4 %) patients with PAFs had to be treated surgically , the others were treated either by ultrasound guided manual compression or conservatively if smaller than 1 cm.
Conclusion: Clinically silent PAF detected by routine US is a frequent post-TAVI minor vascular complication which is more likely to occur after ESV using the Esheath than after CV. Although US-guided compression is highly effective, further miniaturisation of TAVI devices and modification of the Esheath design might help to eliminate post-TAVI PAF.
Author Disclosures: S. Fateh-Moghadam: None. R. Jorbenadze: None. A. Kilias: None. M. Droppa: None. P. Htun: None. M. Gawaz: None. W. Bocksch: None.
- © 2014 by American Heart Association, Inc.