Stefan Stortecky1, Peter Wenaweser2, Nicolas Diehm3, Thomas Pilgrim1, Christoph Huber4, Andrea Bianca Rosskopf5, Ahmed A Khattab1, Lutz Buellesfeld1, Steffen Gloekler1, Balthasar Eberle6, Jürg Schmidli4, Thierry Carrel4, Bernhard Meier1, Stephan Windecker1. 1. Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland. 2. Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland. Electronic address: peter.wenaweser@insel.ch. 3. Department of Clinical, Interventional Angiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland. 4. Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland. 5. Department of Diagnostic, Interventional, and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland. 6. Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland.
Abstract
OBJECTIVES: This study sought to investigate the feasibility and safety of percutaneous management of vascular complications after transcatheter aortic valve implantation (TAVI). BACKGROUND: Vascular complications after TAVI are frequent and outcomes after percutaneous management of these adverse events not well established. METHODS: Between August 2007 and July 2010, 149 patients underwent transfemoral TAVI using a percutaneous approach. We compared outcomes of patients undergoing percutaneous management of vascular complications with patients free from vascular complications and performed duplex ultrasonography, fluoroscopy, and multislice computed tomography during follow-up. RESULTS: A total of 27 patients (18%) experienced vascular complications consisting of incomplete arteriotomy closure (n = 19, 70%), dissection (n = 3, 11%), arterial perforation (n = 3, 11%), arterial occlusion (n = 1, 4%), and pseudoaneurysm (n = 1, 4%). Percutaneous stent graft implantation was successful in 21 of 23 (91%) patients, whereas 2 patients were treated by manual compression, 2 patients underwent urgent surgery, and 2 patients required delayed surgery. Rates of major adverse cardiac events at 30 days were similar among patients undergoing percutaneous management of vascular complications and those without vascular complications (9% vs. 8%, p = 1.00). After a median follow-up of 10.9 months, imaging showed no evidence of hemodynamically significant stenosis (mean peak velocity ratio: 1.2 ± 0.4). Stent fractures were observed in 4 stents (22%, type I [6%], type II [16%]) and were clinically silent in all cases. CONCLUSIONS: Vascular complications after TAVI can be treated percutaneously as a bailout procedure with a high rate of technical success, and clinical outcomes are comparable to patients without vascular complications. Stent patency is high during follow-up, although stent fractures require careful scrutiny.
OBJECTIVES: This study sought to investigate the feasibility and safety of percutaneous management of vascular complications after transcatheter aortic valve implantation (TAVI). BACKGROUND:Vascular complications after TAVI are frequent and outcomes after percutaneous management of these adverse events not well established. METHODS: Between August 2007 and July 2010, 149 patients underwent transfemoral TAVI using a percutaneous approach. We compared outcomes of patients undergoing percutaneous management of vascular complications with patients free from vascular complications and performed duplex ultrasonography, fluoroscopy, and multislice computed tomography during follow-up. RESULTS: A total of 27 patients (18%) experienced vascular complications consisting of incomplete arteriotomy closure (n = 19, 70%), dissection (n = 3, 11%), arterial perforation (n = 3, 11%), arterial occlusion (n = 1, 4%), and pseudoaneurysm (n = 1, 4%). Percutaneous stent graft implantation was successful in 21 of 23 (91%) patients, whereas 2 patients were treated by manual compression, 2 patients underwent urgent surgery, and 2 patients required delayed surgery. Rates of major adverse cardiac events at 30 days were similar among patients undergoing percutaneous management of vascular complications and those without vascular complications (9% vs. 8%, p = 1.00). After a median follow-up of 10.9 months, imaging showed no evidence of hemodynamically significant stenosis (mean peak velocity ratio: 1.2 ± 0.4). Stent fractures were observed in 4 stents (22%, type I [6%], type II [16%]) and were clinically silent in all cases. CONCLUSIONS:Vascular complications after TAVI can be treated percutaneously as a bailout procedure with a high rate of technical success, and clinical outcomes are comparable to patients without vascular complications. Stent patency is high during follow-up, although stent fractures require careful scrutiny.
Authors: E M A Wiegerinck; H A Marquering; N Y Oldenburger; M A Elattar; R N Planken; B A J M De Mol; J J Piek; J Baan Journal: Int J Cardiovasc Imaging Date: 2013-12-11 Impact factor: 2.357
Authors: Kelly D Green; Alain Waked; Usman Majeed; Marat Fudim; Mark A Robbins; Marshall Crenshaw; David Zhao Journal: Tex Heart Inst J Date: 2014-12-01
Authors: Katarzyna Czerwińska-Jelonkiewicz; Ilona Michałowska; Adam Witkowski; Maciej Dąbrowski; Ewa Księżycka-Majczyńska; Zbigniew Chmielak; Krzysztof Kuśmierski; Tomasz Hryniewiecki; Marcin Demkow; Janina Stępińska Journal: J Thromb Thrombolysis Date: 2014-05 Impact factor: 2.300