Author + information
- Marco Barbanti,
- Ronald Binder,
- Melanie Freeman,
- David Wood,
- Jonathon Leipsic,
- Anson Cheung,
- Jian Ye,
- Stefan Toggweiler and
- John Webb
Vascular complications are an important cause for morbidity and mortality in TAVR. New generation devices have incorporated lower profile delivery systems. Whether these new devices reduce vascular complication rates in patients undergoing transcatheter aortic valve replacement (TAVR) is unknown. We sought to assess the impact of low–profile sheaths on vascular complications during transfemoral TAVR.
All patients undergoing transfemoral TAVR from January 2005 to November 2012 at St. Paul's Hospital, Vancouver, Canada, (n=479) were dichotomized according to the size of the sheath (14–18 Fr vs 19–26 Fr). Vascular complications and bleeding were defined according to the VARC definitions.
Overall, 14–18 Fr sheaths were used in 207 cases (43.2%, group 14–18 Fr), while 19–26 Fr sheaths were used in 272 (56.8%, group 19–26 Fr). Patients in the 19–26 Fr group had a higher rate of porcelain aorta (7.7% vs 13.9%, p=0.032); no differences in terms of age, STS score, gender, peripheral vascular disease, diabetes mellitus and severity of ilio–femoral calcifications were observed between groups. On the other hand, patients in the 14–18 Fr group had a lower mean femoral diameter (7.1 ± 1.2 vs 7.7 ± 1.2 mm, p < 0.001), and a higher femoral artery diameter/sheath diameter ratio (0.95 ± 0.2 vs 0.89 ± 0.2, p = 0.026). Lower profile sheaths were associated with lower incidence of major vascular complications (1.0% vs 8.8%, p < 0.001), as well as life–threatening and major bleeding (0.5% vs 5.4%, p<0.001 and 2.5% vs 5.4%, p=0.046). Finally, 19–24 Fr sheaths (adjusted OR 2.21; 95% CI 1.08–4.52) and diabetes mellitus (adjusted OR 2.57; 95% CI 1.07–6.16) were found to be independent predictors of any vascular complications after TAVR.
The introduction of lower profile sheaths has dramatically reduced the incidence of vascular complications and bleeding after transfemoral TAVR, thus enhancing the safety of the procedure.
Moderated Poster Contributions
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2114M–227
- 2013 American College of Cardiology Foundation