BACKGROUND AND PURPOSE: Transcatheter aortic valve implantation (TAVI) is a rapidly emerging treatment option for patients with aortic valve stenosis and high surgical risk. Different access routes have been proposed for TAVI including transapical, transsubclavian and transfemoral, with percutaneous transfemoral being the preferred because least invasive and nonsurgical. However, vascular access site complications due to the large-bore delivery catheters remain an important clinical issue, particularly with respect to the elderly patient collective typically considered for TAVI. In the study, the authors analyzed their 4-year TAVI experience with respect to vascular complications and their management in patients undergoing completely percutaneous transfemoral TAVI procedures. PATIENTS AND METHODS: Since 2006, TAVI was performed in 101 consecutive patients at the West German Heart Center Essen. 33 patients underwent transapical TAVI, eight patients transfemoral TAVI with surgical access or closure, and 60 patients percutaneous transfemoral TAVI using two commercially available prosthetic valve devices. RESULTS: Completely percutaneous TAVI was technically successful in all but one patient with malpositioning in the aortic arch during valve retrieval. There was no intraprocedural death and 30-day mortality was 12% (7/60). Vascular access site complications occurred in 19 patients (32%), necessitating surgical repair in six of them (10%). Complications included retroperitoneal hematoma (n = 2), iliac or femoral artery dissection (n = 10), (pseudo)aneurysm formation (n = 3), and closure device-induced vessel stenosis/ occlusion (n = 6). Of these, 13 cases could be managed either conservatively (n = 5) or by contralateral endovascular treatment (n = 8). CONCLUSION: Completely percutaneous TAVI has a high acute success rate with low intraprocedural and 30-day mortality. The patient collective appears to be prone to vascular complications which remain an important limitation of this novel technique. Although conservative or endovascular management is possible in the majority of cases, further technological developments are obliged to reduce the vascular complication rate.
BACKGROUND AND PURPOSE: Transcatheter aortic valve implantation (TAVI) is a rapidly emerging treatment option for patients with aortic valve stenosis and high surgical risk. Different access routes have been proposed for TAVI including transapical, transsubclavian and transfemoral, with percutaneous transfemoral being the preferred because least invasive and nonsurgical. However, vascular access site complications due to the large-bore delivery catheters remain an important clinical issue, particularly with respect to the elderly patient collective typically considered for TAVI. In the study, the authors analyzed their 4-year TAVI experience with respect to vascular complications and their management in patients undergoing completely percutaneous transfemoral TAVI procedures. PATIENTS AND METHODS: Since 2006, TAVI was performed in 101 consecutive patients at the West German Heart Center Essen. 33 patients underwent transapical TAVI, eight patients transfemoral TAVI with surgical access or closure, and 60 patients percutaneous transfemoral TAVI using two commercially available prosthetic valve devices. RESULTS: Completely percutaneous TAVI was technically successful in all but one patient with malpositioning in the aortic arch during valve retrieval. There was no intraprocedural death and 30-day mortality was 12% (7/60). Vascular access site complications occurred in 19 patients (32%), necessitating surgical repair in six of them (10%). Complications included retroperitoneal hematoma (n = 2), iliac or femoral artery dissection (n = 10), (pseudo)aneurysm formation (n = 3), and closure device-induced vessel stenosis/ occlusion (n = 6). Of these, 13 cases could be managed either conservatively (n = 5) or by contralateral endovascular treatment (n = 8). CONCLUSION: Completely percutaneous TAVI has a high acute success rate with low intraprocedural and 30-day mortality. The patient collective appears to be prone to vascular complications which remain an important limitation of this novel technique. Although conservative or endovascular management is possible in the majority of cases, further technological developments are obliged to reduce the vascular complication rate.
Authors: Alec Vahanian; Helmut Baumgartner; Jeroen Bax; Eric Butchart; Robert Dion; Gerasimos Filippatos; Frank Flachskampf; Roger Hall; Bernard Iung; Jaroslaw Kasprzak; Patrick Nataf; Pilar Tornos; Lucia Torracca; Arnold Wenink Journal: Eur Heart J Date: 2007-01-26 Impact factor: 29.983
Authors: Alain Cribier; Helene Eltchaninoff; Assaf Bash; Nicolas Borenstein; Christophe Tron; Fabrice Bauer; Genevieve Derumeaux; Frederic Anselme; François Laborde; Martin B Leon Journal: Circulation Date: 2002-12-10 Impact factor: 29.690
Authors: Samuel V Lichtenstein; Anson Cheung; Jian Ye; Christopher R Thompson; Ronald G Carere; Sanjeevan Pasupati; John G Webb Journal: Circulation Date: 2006-07-31 Impact factor: 29.690
Authors: Jochen Reinöhl; Constantin von Zur Mühlen; Martin Moser; Stefan Sorg; Christoph Bode; Manfred Zehender Journal: J Thromb Thrombolysis Date: 2013-05 Impact factor: 2.300
Authors: Antonio E Dager; Rutger-Jan Nuis; Bernardo Caicedo; Jaime A Fonseca; Camilo Arana; Lidsa Cruz; Luis M Benitez; Carlos A Nader; Eduardo Duenas; Eduardo J de Marchena; William W O'Neill; Peter P de Jaegere Journal: Tex Heart Inst J Date: 2012
Authors: Rebecca T Hahn; Susheel Kodali; E Murat Tuzcu; Martin B Leon; Samir Kapadia; Deepika Gopal; Stamatios Lerakis; Brian R Lindman; Zuyue Wang; John Webb; Vinod H Thourani; Pamela S Douglas Journal: JACC Cardiovasc Imaging Date: 2015-03
Authors: Jochen Reinöhl; Anja Gutmann; Marc Kollum; Constantin von Zur Mühlen; Hardy Baumbach; Melanie Avlar; Martin Moser; Christoph Bode; Manfred Zehender Journal: J Thromb Thrombolysis Date: 2013-05 Impact factor: 2.300