Faculty Collaboration Database

Unilateral Access Is Safe and Facilitates Peripheral Bailout During Transfemoral-Approach Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019 Nov 11;12(21):2210-2220

Date

11/09/2019

Pubmed ID

31699379

DOI

10.1016/j.jcin.2019.06.050

Scopus ID

2-s2.0-85073952298 (requires institutional sign-in at Scopus site)   26 Citations

Abstract

OBJECTIVES: The aim of this study was to compare the rate and trend of vascular complications when placing a second arterial sheath in the contralateral femoral artery during transcatheter aortic valve replacement (TAVR) unilaterally versus bilaterally.

BACKGROUND: Vascular complications occur in approximately 5% to 8% of TAVR procedures. Many operators place a second arterial sheath in the contralateral femoral artery to perform aortic root angiography. The authors surmised that placing the second sheath ipsilateral and distal to the delivery sheath would be an easier option with similar safety.

METHODS: The Cleveland Clinic Aortic Valve Center TAVR database was accessed, and data for patients undergoing transfemoral TAVR (TF-TAVR) from January 2014 to December 2017 were analyzed retrospectively. The primary outcome was the rate of peripheral vascular complications.

RESULTS: A total of 1,208 patients who underwent TF-TAVR were included in this study. One thousand seven patients (83.36%) underwent bilateral femoral access, and 201 patients (16.64%) underwent TF-TAVR using a unilateral femoral approach. Over the study duration, use of the unilateral access approach trended upward significantly, reaching 43.7% of total cases in 2017. A gradual decline in access site-related vascular complications was observed, from 13.7% in 2014 to 7.4% in 2017. After propensity-score matching, peripheral vascular complications were similar between bilateral access and unilateral access (10.8% vs. 8.6%) (p = 0.543).

CONCLUSIONS: There was a significant decline in vascular complications from 2014 to 2017. Unilateral-access TF-TAVR provided similar safety compared with bilateral-access TF-TAVR and is a more accessible approach for managing access site-related complications and possibly achieving better patient satisfaction.

Author List

Khubber S, Bazarbashi N, Mohananey D, Kadri A, Gad MM, Kaur M, Sammour YM, Lyden M, Ahuja KR, Verma B, Menon V, Mick SL, Reed GW, Puri R, Svensson L, Navia JL, Tuzcu EM, Krishnaswamy A, Kapadia SR

Author

Divyanshu Mohananey MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Catheterization, Peripheral
Databases, Factual
Female
Femoral Artery
Heart Valve Prosthesis
Humans
Male
Ohio
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
Vascular Access Devices
Vascular Diseases