Author + information
- Received April 18, 2019
- Revision received June 13, 2019
- Accepted June 19, 2019
- Published online November 4, 2019.
- Shameer Khubber, MD∗,
- Najdat Bazarbashi, MD∗,
- Divyanshu Mohananey, MD,
- Amer Kadri, MD,
- Mohamed M. Gad, MD,
- Manpreet Kaur, MD,
- Yasser M. Sammour, MD,
- Megan Lyden, BS,
- Keerat R. Ahuja, MD,
- Beni Verma, MD,
- Vivek Menon, MD,
- Stephanie L. Mick, MD,
- Grant W. Reed, MD,
- Rishi Puri, MBBS, PhD,
- Lars Svensson, MD, PhD,
- Jose L. Navia, MD,
- E. Murat Tuzcu, MD,
- Amar Krishnaswamy, MD and
- Samir R. Kapadia, MD∗ ()
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Samir R. Kapadia, Interventional Cardiology, Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195.
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.
- transcatheter aortic valve replacement
- unilateral access sheath placement
- vascular complications
↵∗ Drs. Khubber and Bazarbashi contributed equally to this work and are joint first authors.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 18, 2019.
- Revision received June 13, 2019.
- Accepted June 19, 2019.
- 2019 American College of Cardiology Foundation
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