Percutaneous management of vascular complications in patients undergoing transcatheter aortic valve implantation

Stefan Stortecky, Peter Wenaweser, Nicolas Diehm, Thomas Pilgrim, Christoph Huber, Andrea Bianca Rosskopf, Ahmed A Khattab, Lutz Buellesfeld, Steffen Gloekler, Balthasar Eberle, Jürg Schmidli, Thierry Carrel, Bernhard Meier, Stephan Windecker
JACC. Cardiovascular Interventions 2012, 5 (5): 515-524

OBJECTIVES: This study sought to investigate the feasibility and safety of percutaneous management of vascular complications after transcatheter aortic valve implantation (TAVI).

BACKGROUND: Vascular complications after TAVI are frequent and outcomes after percutaneous management of these adverse events not well established.

METHODS: Between August 2007 and July 2010, 149 patients underwent transfemoral TAVI using a percutaneous approach. We compared outcomes of patients undergoing percutaneous management of vascular complications with patients free from vascular complications and performed duplex ultrasonography, fluoroscopy, and multislice computed tomography during follow-up.

RESULTS: A total of 27 patients (18%) experienced vascular complications consisting of incomplete arteriotomy closure (n = 19, 70%), dissection (n = 3, 11%), arterial perforation (n = 3, 11%), arterial occlusion (n = 1, 4%), and pseudoaneurysm (n = 1, 4%). Percutaneous stent graft implantation was successful in 21 of 23 (91%) patients, whereas 2 patients were treated by manual compression, 2 patients underwent urgent surgery, and 2 patients required delayed surgery. Rates of major adverse cardiac events at 30 days were similar among patients undergoing percutaneous management of vascular complications and those without vascular complications (9% vs. 8%, p = 1.00). After a median follow-up of 10.9 months, imaging showed no evidence of hemodynamically significant stenosis (mean peak velocity ratio: 1.2 ± 0.4). Stent fractures were observed in 4 stents (22%, type I [6%], type II [16%]) and were clinically silent in all cases.

CONCLUSIONS: Vascular complications after TAVI can be treated percutaneously as a bailout procedure with a high rate of technical success, and clinical outcomes are comparable to patients without vascular complications. Stent patency is high during follow-up, although stent fractures require careful scrutiny.

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