Author + information
- Mir B. Basir,
- Carlos Velez,
- Brittany Fuller,
- Gaetano Paone,
- Dee Dee Wang,
- Mayra Guerrero,
- Adam Greenbaum and
- William O'Neill
Vascular complications are a major source of morbidity and mortality associated with transcatheter aortic valve replacement (TAVR). As smaller delivery systems emerge we sought to identify differences in vascular access use.
We analyzed all patients who had undergone TAVR in a single center from March 2012 to May 2014. We identified all patients who had undergone non-femoral TAVR. We reviewed the femoral dimensions of all patients using CT imaging taking into account vessel tortuosity, calcification, vascular pathology, and two-dimensional minimal lumen diameter (MLD). We then identified those patients in whom a smaller delivery system could have been used if such technology was available at that time.
In total 208 TAVRs were performed,129 cases using femoral arterial access and 75 cases using non-femoral access. 28 transapical, 27 transcaval, 12 transaortic and 8 via an antegrade approach using the femoral vein thereafter requiring atrial septostomy. Of the 75 non-femoral access cases, 63 were completed using commercially available first-generation valves and 12 using second-generation valves under research protocols. MLD required for each delivery system was based on the manufacture’s recommendation.
Of the 63 cases performed via a non-femoral route using a first generation valve, 31 cases could have been approached via a transfemoral (TF) route using second-generation delivery systems; and 48 cases could have been approached via a TF route using third generation delivery systems. Of the 12 cases performed via a non-femoral route using a second-generation valve, 4 cases could have been approached via a TF route using a third-generation delivery system.
In total, only 11% patients undergoing TAVR could not accommodate smaller second and third generation delivery system. 16 of these 22 patients could not accommodate third generation delivery systems due to the small minimal lumen diameter of the iliofemoral vessels. The other 6 could not accommodate smaller delivery sheath due to vascular pathology.
With the use of smaller delivery systems our institution can expect to perform 89% of TAVRs via a typical retrograde TF approach.