Clinical outcomes following single access transfemoral transcatheter aortic valve implantation

Abstract

Objectives We describe the first experience using calcification of anatomical landmarks to obviate the need for transcatheter aortic valve implantation (TAVI) alignment aortography and secondary TAVI access. Background TAVI alignment conventionally involves secondary femoral access for contrast aortography using a second catheter. Secondary femoral access accounts for up to 25% of all vascular complications. Heavily calcified aortic leaflets are often visible fluoroscopically and can act as markers for TAVI alignment. Methods We considered 100 consecutive patients for transfemoral TAVI. The first group was considered for a conventional dual access technique and the subsequent group was considered for a single access technique. Relevant baseline, and procedural and outcome measures were recorded. Results Baseline characteristics were comparable between groups. Balloon‐expandable transcatheter heart valves (THV) were used in all cases. THV implantation was successful in 100% of cases with no procedural or in‐hospital mortality. Procedural time and contrast use were lower in the single access group. There were no Valve Academic Research Consortium (VARC)‐2 major vascular complications with the single access technique. Conclusions This is the first study describing the use of calcification of anatomical landmarks to obviate the need for secondary TAVI access. Notable observations included successful device implantation in all cases, no VARC‐2 major vascular complications, comparable rates of paravalvular leak and permanent pacemaker requirement, shorter procedural times, and lower contrast use. Single access TAVI is a viable alternative technique to minimize vascular access, contrast use, and procedural duration in experienced centers and with selected patients, allowing successful device implantation and low complication rates while further streamlining TAVI workflow.

Single-access, non-contrast transcatheter aortic valve implantation, the ultimate minimalist approach: a case report

“…It was associated with a shorter procedural time and lower use of contrast media. 12 Moreover, single-access TAVI has a comparable procedural success to dual access with similar rates of major vascular complications. 12 Whilst the right brachial artery could have been used, this may add additional vascular risk, and the fluoroscopic anatomical features provided sufficient landmarks to safely deploy the transcatheter heart valve without the need to use a pig-tail catheter.…”

“… 12 Moreover, single-access TAVI has a comparable procedural success to dual access with similar rates of major vascular complications. 12 Whilst the right brachial artery could have been used, this may add additional vascular risk, and the fluoroscopic anatomical features provided sufficient landmarks to safely deploy the transcatheter heart valve without the need to use a pig-tail catheter. The fluoroscopic calcium distribution within the aortic valve leaflets, the aortic annulus, and the left ventricle outflow tract was comparable with that visible on CT and allowed a precise implantation of the transcatheter heart valve.…”

Single femoral artery access is safe and feasible during transcatheter aortic valve replacement: a propensity score matched analysis

“…Previous studies have explored the possibility of eliminating secondary access. Some researchers compared the effects of puncturing only 1 femoral artery as the primary access with the effects of conventional dual artery (DA) access and reported promising results (14). However, they used aortic root calcifications as landmarks to avoid the use of angiography, which requires rigorous patient selection and is rarely used.…”

A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence

“…Moreover, the transition from secondary femoral to radial access for guiding valve deployment and assessing the vascular closure of the primary access has further simplified TAVI and has substantially reduced the risk of vascular complications ( 5 ). A newly introduced minimalistic technique incorporating a single arterial transfemoral access and the use of aortic valve leaflet calcifications as the fluoroscopic markers for THV positioning has shown promising results as a safe and effective approach associated with a lower rate of complications, procedural time, and contrast volume during the implantation of the Sapien 3 THV system ( Figure 3 ) ( 6 ).…”