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The transfemoral (TF) transcatheter aortic valve replacement (TAVR) device commercially available in the US requires large vessel size. The impact of device iterations on the need for alternative access remains unclear.
A large single center series of patients undergoing TAVR were studied. Data on prospectively measured minimal lumen dimension (MLD) on computed tomography (CT) of the iliofemoral vasculature was collected for each patient. Proportions of patients suitable for a transfemoral access approach were identified with progressively lower MLD cut–offs required by reducing device profile (24 Fr to 14 Fr).
Data were analyzed for 277 patients undergoing TAVR with a balloon expandable prosthesis for severe aortic stenosis with both TF and transapical (TA) approaches available. Mean age was 83.7±8.7 years. A TF approach was employed for 83.8% of patients, with 16.2% treated by the TA approach. A total of 85% were treated with an Edwards–Sapien device and 15% with the Edwards–Sapien XT. Although only 41% were suitable for a transfemoral approach if a 24Fr device were used, 90% were suitable if an 18Fr device were used (p<0.001). The proportion suitable increased from 90% to 96% if a 14Fr device were available (p<0.001). Data will be updated for >500 consecutive patients.
In this series, 90% of patients were anatomically suitable for a transfemoral approach using 18 Fr devices. This progressively relegates alternative access procedures to a niche role.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Interventional Aspects of CT and Other Novel Imaging Approaches
Abstract Category: 37. TCT@ACC–i2: Angiography and Interventional Aspects of CT/MR
Presentation Number: 2112–252
- 2013 American College of Cardiology Foundation