Abstract 16093: Very Low Rates of Vascular Complications Can Be Achieved After Transcatheter Aortic Valve Implantation(tavi) Performed With Surgical Femoral Access
Objectives: Access site vascular complications (VC) remain a major concern after Transcatheter Aortic Valve implantation (TAVI). We therefore evaluated results of an exclusive surgical strategy for both access and closure of the femoral artery after TAVI.
Methods: Between 2010-2014, we conducted a monocenter registry which included consecutive patients who had a TAVI procedure via transfemoral access using low profile 18- to 20F sheath system. Surgical cutdown and closure of the femoral artery were used for all patients. VC associated with the TAVI access site were evaluated within 30 days and classified as major or minor according to the VARC(Valve Academic Research Consortium)definition.
Results: The study enrolled 396 patients with median age of 84 years (IQR = 81-88) and included 218 (55.1%) women. The median Euroscore was 18.5% (IQR=11-23). An Edwards Sapiens or a Medtronic Corevalve prosthesis were used for respectively 72.5% (n=287) and 26.5% (n=105) of patients.
VC occurred in 20 patients (6%) with only 8 patients (2%) with major VC (table 1).
Transfusions were required in 57 patients (14%), with only one unit of red blood cells needed for the vast majority of patients.
The total length of the procedure was 68 +/- 15 minutes including 13 +/- 5 minutes for the surgical access. In hospital mortality was 3.2% (n=13). In multivariable analysis, only diabetes (OR 2.8 ; 1.1-6.7, p=0.02 ) and chronic kidney failure (OR 3.2 (1.1-9.5), p=0.04) were predictive of VC while sheath size (p=0.9), body mass index (p=0.74), sex (p=0.6), Euroscore (p=0.6) and lower limb arteriopathy (p=0.7) were not.
Conclusions: Surgical vascular access for TAVI appears simple and feasable and is associated with a very low rate of major vascular complications. Direct comparison between the surgical and the percutaneous approach may be relevant, particularly for high risk bleeding patients.
Author Disclosures: M. Akodad: None. E. Nogue: None. N. Nagot: None. J. Macia: None. T. Gandet: None. B. Albat: None. G. Cayla: None. R. Gervasoni: None. D. Delseny: None. F. Leclercq: None.
- © 2014 by American Heart Association, Inc.