Transfemoral transcatheter aortic valve implantation in patients with small diseased peripheral vessels

Neil Ruparelia, Nicola Buzzatti, Vittorio Romano, Matteo Longoni, Fillipo Figini, Matteo Montorfano, Hiroyoshi Kawamoto, Tadashi Miyazaki, Pietro Spagnolo, Ottavio Alfieri, Antonio Colombo, Azeem Latib

Research output: Contribution to journalArticle

Abstract

Objectives: The aim of this study was to assess the feasibility, safety and short-term outcomes of transfemoral transcatheter aortic valve implantation (TF-TAVI) in patients with small diseased peripheral vessels. Background: The transfemoral (TF) route for transcatheter aortic valve (TAVI) is the default option due to associated advantages. However, this is limited due to the high prevalence of significant peripheral arterial disease and increased risk of vascular complications. Methods: Of 539 consecutive patients undergoing TAVI in a single Italian center, 23 patients underwent TF-TAVI in the presence of small peripheral vessels as defined by a minimal luminal diameter (MLD) of ≤ 5.5. mm [by computed tomography (CT)] and/or the inability to advance a large-bore sheath. Calcification was defined as being concentric if calcium extended more than 270° around the circumference of the artery. All patients underwent 30-day clinical follow-up. Results: 17 (73.9%) patients underwent peripheral vessel pre-dilatation with a semi-compliant balloon and 6 (26.1%) patients with a Solopath sheath. 6 (26.1%) patients suffered a peri-procedural complication, with 1 patient requiring surgical embolectomy for thrombotic occlusion and the remaining patients successfully managed percutaneously in the catheter laboratory. No patient suffered a vessel perforation or required implantation of a covered stent. At 30-day follow-up, all patients were free of symptoms and signs or symptoms of peripheral vascular disease, with well-functioning TAVI prostheses as evaluated by echocardiography. Conclusions: Performing TF-TAVI is feasible in patients with no other viable vascular access option in the presence of small MLD and calcification of the peripheral vasculature, with any anticipated acute vascular complication managed in the catheter laboratory with established percutaneous techniques.

Original languageEnglish
Pages (from-to)326-330
Number of pages5
JournalCardiovascular Revascularization Medicine
Volume16
Issue number6
DOIs
Publication statusPublished - Sep 1 2015

Keywords

  • Peripheral access
  • TAVI
  • Transcatheter aortic valve implantation
  • Vascular access

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Ruparelia, N., Buzzatti, N., Romano, V., Longoni, M., Figini, F., Montorfano, M., Kawamoto, H., Miyazaki, T., Spagnolo, P., Alfieri, O., Colombo, A., & Latib, A. (2015). Transfemoral transcatheter aortic valve implantation in patients with small diseased peripheral vessels. Cardiovascular Revascularization Medicine, 16(6), 326-330. https://doi.org/10.1016/j.carrev.2015.05.013