Percutaneous Aortic Valve Replacement: Vascular Outcomes With a Fully Percutaneous Procedure
What are the vascular complications in a consecutive patient population undergoing transfemoral percutaneous aortic valve replacement (PAVR), when applying current Valve Academic Research Consortium definitions?
All patients undergoing transfemoral PAVR during fiscal years 2009 and 2010 were prospectively evaluated at baseline, after the procedure, and at 30 days. Continuous parametric variables were compared using Student t test. Continuous nonparametric variables (Society of Thoracic Surgeons score, length of hospital stay) were compared using the Mann-Whitney U test for two test groups and the Kruskal-Wallis test for >2 groups.
PAVR was performed in 137 consecutive patients. All but one patient underwent planned arteriotomy closure using a percutaneous preclosure technique. Smaller sheaths, rigorous angiographic and computed tomographic (CT) screening and patient selection, and percutaneous vascular repair techniques were increasingly used over this period. From 2009 to 2010, major vascular complications decreased from 8% to 1% (p = 0.06), minor vascular complications decreased from 24% to 8% (p < 0.01), major bleeds fell from 14% to 1% (p < 0.01), and unplanned surgery decreased from 28% to 2% (p < 0.01). A minimal artery diameter smaller than the external sheath diameter, moderate or severe calcification, and peripheral vascular disease were associated with higher vascular complication rates.
The authors concluded that vascular complications occur more often if the minimal artery diameter is smaller than the external sheath diameter, in the presence of moderate or severe calcification, and in patients with peripheral vascular disease.
This study suggests that the risk for vascular complications is higher in patients with a minimal iliofemoral artery diameter that is smaller than the external sheath diameter (as determined by angiography or multidetector CT [MDCT]), in the presence of moderate or severe calcification (as determined by MDCT), and in patients with peripheral vascular disease. Although, open surgical access and closure of the femoral artery has been advocated to reduce complication rates when using the large sheaths required for PAVR, it appears that with careful patient selection and advanced interventional techniques, very low complication rates can be achieved with a fully percutaneous procedure.
Keywords: Heart Valve Prosthesis, Tomography, X-Ray Computed, Femoral Artery, Peripheral Vascular Diseases
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