Factors associated with vascular complications in patients undergoing balloon-expandable transfemoral transcatheter aortic valve replacement via open versus percutaneous approaches.
Publication/Presentation Date
8-1-2014
Abstract
BACKGROUND: Vascular complications after transfemoral transcatheter aortic valve replacement are common and associated with significant morbidity and mortality. Little is known about the effect of access approach on vascular complications.
METHODS AND RESULTS: Between 2007 and 2013, 331 patients underwent transfemoral transcatheter aortic valve replacement via open surgical (OS) or fully percutaneous (PC) approaches. Patient data and clinical outcomes were collected. Valve Academic Research Consortium-defined vascular complications were noted. Multivariable analysis with propensity matching was performed, and vascular complications, mortality, and length of stay were assessed. One hundred twenty patients were treated with the OS approach and 211 patients via the PC approach. There were fewer major vascular complications (11% versus 20%; P=0.03) and shorter length of stay (7.5 versus 9.9 days; P=0.003) in the PC group when compared with those in the OS group. In multivariable analysis, vascular complications were more likely in women (odds ratio, 2.2; P=0.02) and with increasing differences between sheath outer diameter and minimal artery diameter (overall vascular complications: odds ratio, 1.4; P=0.02 and major vascular complications: odds ratio, 2.0; P
CONCLUSIONS: Transfemoral transcatheter aortic valve replacement performed via the PC route is associated with similar risk of vascular complications and significantly lower postprocedural length of stay than the OS route. The degree of sheath oversizing with respect to iliofemoral minimal artery diameter and female sex are associated with vascular complications regardless of access approach.
Volume
7
Issue
4
First Page
570
Last Page
576
ISSN
1941-7632
Published In/Presented At
Kadakia, M. B., Herrmann, H. C., Desai, N. D., Fox, Z., Ogbara, J., Anwaruddin, S., Jagasia, D., Bavaria, J. E., Szeto, W. Y., Vallabhajosyula, P., Li, R., Menon, R., Kobrin, D. M., & Giri, J. (2014). Factors associated with vascular complications in patients undergoing balloon-expandable transfemoral transcatheter aortic valve replacement via open versus percutaneous approaches. Circulation. Cardiovascular interventions, 7(4), 570–576. https://doi.org/10.1161/CIRCINTERVENTIONS.113.001030
Disciplines
Medicine and Health Sciences
PubMedID
25027520
Department(s)
Department of Surgery
Document Type
Article