Management of vascular complications following transcatheter aortic valve implantation

Nils Perrin, Christoph Ellenberger, Marc Licker, Anne-Lise Hachulla, Mustafa Cikirikcioglu, Angela Frei, Marco Roffi, Stéphane Noble
Archives of Cardiovascular Diseases 2015, 108 (10): 491-501

BACKGROUND: Vascular complications (VCs) after transcatheter aortic valve implantation (TAVI) are frequent and their management is challenging.

AIM: To report the incidence, predictors and management of VCs following percutaneous transfemoral TAVI (TF-TAVI) at a single centre.

METHODS: We analyzed 102 consecutive patients who underwent percutaneous TF-TAVI between August 2008 and December 2013. All endpoints were evaluated at 30 days and 6 months according to Valve Academic Research Consortium-2 criteria. VC percutaneous treatment success was defined as residual stenosis<30%, absence of blood extravasation and absence of surgical or repeat endovascular intervention at 30 days.

RESULTS: Twenty-two patients (22%) experienced VCs, including five patients (5%) with major VCs. Mortality at 30 days was significantly higher in patients with major VCs than in patients without major VCs (60% vs 3%; P=0.001). Patients with VCs had more life-threatening or major bleeding (23% vs 5%; P=0.02), but no difference in terms of need for blood transfusion was observed. Endovascular treatment was used in 13 of 22 patients with VCs (59%) and was successful in 11 of these 13 patients (85%). Primary surgical repair was necessary in only 1/22 (5%) patients, for a common femoral artery pseudoaneurysm 2 weeks after the TAVI procedure.

CONCLUSIONS: VCs following TF-TAVI are frequent. Major but not minor VCs are associated with increased mortality. Percutaneous management of VCs is feasible and safe, and surgery is rarely needed.

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