Author + information
- Received September 29, 2011
- Revision received December 2, 2011
- Accepted January 11, 2012
- Published online May 1, 2012.
- Stefan Stortecky, MD⁎,
- Peter Wenaweser, MD⁎,⁎ (, )
- Nicolas Diehm, MD†,
- Thomas Pilgrim, MD⁎,
- Christoph Huber, MD‡,
- Andrea Bianca Rosskopf, MD§,
- Ahmed A. Khattab, MD⁎,
- Lutz Buellesfeld, MD⁎,
- Steffen Gloekler, MD⁎,
- Balthasar Eberle, MD∥,
- Jürg Schmidli, MD‡,
- Thierry Carrel, MD‡,
- Bernhard Meier, MD⁎ and
- Stephan Windecker, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Peter Wenaweser, Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freiburgstrasse 10, 3010 Bern, Switzerland
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.
This study was supported by research grants from Bern University Hospital and a grant of the Swiss National Science Foundation to Dr. Windecker (SNF Grant 32003B_135807). Dr. Stortecky has received a research fellowship funded by the Swiss National Science Foundation. Dr. Wenaweser received lecture and consultant fees from Edwards Lifesciences and Medtronic CoreValve. Dr. Huber is a proctor for Edwards Lifesciences and a consultant for Medtronic. Dr. Khattab is a proctor for Medtronic and Edwards Lifesciences. Dr. Buellesfeld is a trainer and consultant for Medtronic. Dr. Eberle received lecture honoraria from Medtronic CoreValve. Dr. Windecker also received lecture and consultant fees from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 29, 2011.
- Revision received December 2, 2011.
- Accepted January 11, 2012.
- 2012 American College of Cardiology Foundation