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Vascular Complications Associated with Transfemoral Aortic Valve Replacement
07 September 2015 (online)
Background Transfemoral aortic valve replacement (TAVR) is a novel technique for treating aortic stenosis, yet vascular complications are yet to be delineated.
Objectives This study aims to study the vascular complications of TAVR with Edwards Sapien valves (Edwards Lifesciences Corp., Irvine, CA).
Methods We performed a retrospective evaluation of TAVR patients. Standard demographics, femoral vessel and sheath size, access type (femoral cut-down [FC], percutaneous access [PFA], and iliac conduit [IC]), and treatment method were recorded. Complications were defined by the Valve Academic Research Consortium Criteria. Logistic regression was used for statistical analysis.
Results A total of 99 patients underwent TAVR between February 15, 2012 and July 17, 2013 with an Edwards Sapien valve. Out of which, 48 were males with a mean age of 83 ± 7 years. Overall, 33 had FC, 58 had PFA, and 6 had an IC. A total of 17 major (2 aortic and 15 iliac) and 38 minor complications (36 access and 2 emboli) occurred. Aortic complications were managed by open repair (OR, 1) or percutaneous repair (PR, 1). Overall, 12 iliac injuries were managed by PR and 3 by OR. Out of the 33 groin complications in FC patients 8 (24%) were treated by OR, whereas 30 (52%) of the 58 groin complications in PTA patients were treated by PR. There were no differences in transfusion requirements or length of stay.
Conclusion Vascular complications of TAVR are common with most being minor, related to access site and causing no immediate sequelae. Iliac injury can be managed by PR or OR. Aortic injury is associated with significant mortality. These findings increase vascular surgeons' awareness of these complications and how to manage them.
- 1 Cribier A, Eltchaninoff H, Bash A , et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 2002; 106 (24) 3006-3008
- 2 Kodali SK, Williams MR, Smith CR , et al; PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366 (18) 1686-1695
- 3 Généreux P, Head SJ, Van Mieghem NM , et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies. J Am Coll Cardiol 2012; 59 (25) 2317-2326
- 4 Leon MB, Smith CR, Mack M , et al; PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363 (17) 1597-1607
- 5 Webb JG, Wood DA. Current status of transcatheter aortic valve replacement. J Am Coll Cardiol 2012; 60 (6) 483-492
- 6 Leon MB, Piazza N, Nikolsky E , et al. Standardized endpoint definitions for Transcatheter Aortic Valve Implantation clinical trials: a consensus report from the Valve Academic Research Consortium. J Am Coll Cardiol 2011; 57 (3) 253-269
- 7 Vandy FC, Girotti M, Williams DM , et al. Iliofemoral complications associated with thoracic endovascular aortic repair: frequency, risk factors, and early and late outcomes. J Thorac Cardiovasc Surg 2014; 147 (3) 960-965
- 8 Généreux P, Webb JG, Svensson LG , et al; PARTNER Trial Investigators. Vascular complications after transcatheter aortic valve replacement: insights from the PARTNER (Placement of AoRTic TraNscathetER Valve) trial. J Am Coll Cardiol 2012; 60 (12) 1043-1052
- 9 Mwipatayi BP, Picardo A, Masilonyane-Jones TV , et al. Incidence and prognosis of vascular complications after transcatheter aortic valve implantation. J Vasc Surg 2013; 58 (4) 1028-36.e1
- 10 Ducrocq G, Francis F, Serfaty JM , et al. Vascular complication of transfemoral aortic aortic valve implantation with the Edwards SAPIEN prosthesis: incidence and impact on outcome. EuroIntervention 2010; 5 (6) 666-672
- 11 Hayashida K, Lefèvre T, Chevalier B , et al. Transfemoral aortic valve implantation new criteria to predict vascular complications. JACC Cardiovasc Interv 2011; 4 (8) 851-858
- 12 Hayashida K, Lefèvre T, Chevalier B , et al. True percutaneous approach for transfemoral aortic valve implantation using the Prostar XL device: impact of learning curve on vascular complications. JACC Cardiovasc Interv 2012; 5 (2) 207-214
- 13 Kahlert P, Al-Rashid F, Weber M , et al. Vascular access site complications after percutaneous transfemoral aortic valve implantation. Herz 2009; 34 (5) 398-408
- 14 Mousa AY, Campbell JE, Broce M , et al. Predictors of percutaneous access failure requiring open femoral surgical conversion during endovascular aortic aneurysm repair. J Vasc Surg 2013; 58 (5) 1213-1219
- 15 Manunga JM, Gloviczki P, Oderich GS , et al. Femoral artery calcification as a determinant of success for percutaneous access for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2013; 58 (5) 1208-1212
- 16 Van Mieghem NM, Tchetche D, Chieffo A , et al. Incidence, predictors, and implications of access site complications with transfemoral transcatheter aortic valve implantation. Am J Cardiol 2012; 110 (9) 1361-1367