Predictors of Vascular Access Complications during Percutaneous Transcutaneous Transcatheter Aortic Valve Repair
ALBEIR MOUSA, MD.,FACS.,RPVI.,MPH.,MBA, Arvindra Nanjundappa, MD., FACC, Michael Yacoub, MD., RPVI, Mark Bates, MD., FACC, Ali AbuRahma, MD.,FACS.,RVI..
West Virginia Univeristy, Charleston, WV, USA.
Objective(s): Transcatheter aortic valve repair (TAVR) has evolved as an alternative therapeutic modality for high surgical risk patients with severe aortic valve stenosis. Although delivery catheters for TAVR are usually large-bore, the preferred access approach tends to be percutaneous transfemoral (TF). The aim of this study was to determine significant predictors of vascular complications requiring intervention (RI) during TF-TAVR. Methods: The current study was a single-center retrospective review of all TF-TAVR patients from January 2013 to January 2017. All vascular access complications (VAC) were classified according to the Valve Academic Research Consortium 2 guidelines (VARC2). Femoral access risk ratio was defined as sheath size (Fr) / minimal FA diameter (mm). The primary outcome variable was any major vascular complication such as, dissection, perforation and/or stenosis that required percutaneous and/or surgical intervention (RI). Target vessel (TV) calcification was categorized as mild, moderate and severe based on (circumferential calcium arc <1/3, 1/3 to ½ and >½ respectively), dyslipidemia was defined as LDL > 130 mg/dl or receiving lipid lowering medication, and obesity was defined as BMI> 30. Multivariate analysis of clinical and anatomic variables was used to determine the significant predictors of RI. Results: A total of 187 consecutive TF-TAVR cases were reviewed, of which 151 were accessed by TF. Average age was 76+8 years, vessel size of 8.1+1.8 mm, sheath size of 18-24 Fr., BMI of 37.6+5.3, and eGFR of 68.5+24.2 ml/mn. The 30-day mortality rate was 4.3% (n=8). Co-morbidities included dyslipidemia in 117 patients (77.5%), and diabetes in 58 patients (38.4%). Among the transfemoral approaches, 29 (19.2%) had major complications and RI. Following multivariate analysis, Femoral access risk ratio (Odds Ratio (OR): 2.6, p<0.001), severely calcified arteries (OR: 2.5, p<0.001) and female gender (OR: 2.2, p=0.017) were all also significant. Conclusion: Although the major vascular complication rate was low, several factors including femoral access risk ratio, vessel calcification and female gender were found to be independent predictors of femoral access failure. Overall, TF-TAVR was found to be feasible, safe, and reliable.
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