Incidence, Predictors, and Implications of Access Site Complications With Transfemoral Transcatheter Aortic Valve Implantation

Mieghem, Nicolás M. Van; Tchétché, Didier; Chieffo, Alaide; Dumonteil, Nicolas; Messika–Zeitoun, David; Boon, Robert M.A. van der; Vahdat, Olivier; Buchanan, Gill Louise; Marcheix, Bertrand; Himbert, Dominique; Serruys, Patrick W.; Fajadet, Jean; Colombo, Antonio; Carrié, Didier; Vahanian, Alec; Jaegere, Peter P.T. de

doi:10.1016/j.amjcard.2012.06.042

Cited by 221 publications

(179 citation statements)

References 29 publications

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“…4 Furthermore, no detrimental impact of stent graft placement on mortality was found in this study, 11 which is conclusive with a recent meta-analysis showing that the Viabahn stent graft is a safe and effective option for symptomatic superior femoral artery lesions. 23 In our cohort, angiographic assessment after a median follow-up of 345 days revealed only one patient with moderate, asymptomatic instent-stenosis (1.0%).…”

Section: Stent Graft Placement For Asarvisupporting

confidence: 77%

“…2,3 The majority of these complications affect the common femoral and external iliac artery, and, among others, include access-site bleeding mostly because of closure device failure, vessel dissection, or rupture. [4][5][6] With the lack of specific guidelines, acute management of vascular complications largely depends on the type of complication and the operator's experience and preference. Possible treatment options range from conservative treatment with manual compression with or without the use of protamine, endovascular approaches with use of balloon occlusion, or implantation of covered stent grafts to open surgical management.…”

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confidence: 99%

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Routine Endovascular Treatment With a Stent Graft for Access-Site and Access-Related Vascular Injury in Transfemoral Transcatheter Aortic Valve Implantation

Sedaghat

Neumann

Schahab

et al. 2016

Circ: Cardiovascular Interventions

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Background-Access-site and access-related vascular injury (ASARVI) is still a major limiting factor in transcatheter aortic valve implantation and affects the outcome of patients. Management strategies for ASARVI include manual compression, stent grafts, and vascular surgery. We hypothesized that the standard use of a self-expanding stent graft for the management of ASARVI is feasible and safe. Methods and Results-Of 407 patients treated by transfemoral transcatheter aortic valve implantation, 110 experienced ASARVI (27.0%). Of these, 96 (87.3%) were managed by the implantation of a self-expanding nitinol stent graft. In the majority of patients, minor vascular complications triggered the implantation of a stent graft (86.5%), mainly because of bleeding (90.6%) and dissection (5.2%) of the common femoral artery with high rates of primary treatment success (97.9%

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Section: Stent Graft Placement For Asarvisupporting

confidence: 77%

mentioning

confidence: 99%

Routine Endovascular Treatment With a Stent Graft for Access-Site and Access-Related Vascular Injury in Transfemoral Transcatheter Aortic Valve Implantation

Sedaghat

Neumann

Schahab

et al. 2016

Circ: Cardiovascular Interventions

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“…33) This was further confirmed in other trials assessing the 30-day and 1-year all-cause mortality. 34,35) There are several potential mechanisms that may explain the correlation of SBE and decreased survival. Firstly, the acute anemia and blood loss induce hemodynamic instability, which may lead to prolonged ischemia and hypotension resulting in end organ damage.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation

et al. 2016

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SummaryThere are differences in reporting bleeding complications after transcatheter aortic valve implantation (TAVI), which is a consequence of the lack of consensus for their definition. Furthermore, the amount of data on the impact of peri-procedural bleeding on the mid-term prognosis is still limited. The aim of this study was to investigate the incidence, predictors, and impact of life-threatening and major bleedings as defined by the Valve Academic Research Consortium 2 (VARC-2) in patients after TAVI over the mid-term prognosis.Consecutive patients who underwent TAVI from March 2010 to December 2013 were included. All data were classified according to the VARC-2 criteria. We assessed the incidence and the predictors of serious bleeding events (SBE), defined as life-threatening/disabling (LT/D) or major bleeding, and analyzed their impact on 30-day and 1-year clinical outcome.A total of 129 patients were included (79.1 ± 8.3 years; mean EuroSCORE = 17.8 ± 12.7). The SBE occurred in 25 patients (19.4%), of which 9 (7.0%) had LT/D and 16 (12.4%) had major bleeding. Trans-subclavian (TS) access (OR 4.38, 95% CI 2.13-14.29, P = 0.01) and diabetes (OR 2.93, 95% CI 1.08-7.93, P = 0.03) were identified as independent predictors of SBE. Patients with SBE had higher 30-day mortality (20.0% versus 4.0%, P = 0.02) and 1-year mortality (40.0% versus 11.1%, P < 0.002). SBE independently predicted 1-year, all-cause mortality (HR 5.88, 95% CI 1.73-19.94, P = 0.005).SBE are frequent after TAVI and are associated with decreased short and mid-term survival. Diabetes and TS access are independent risk factors for SBE. (Int Heart J 2016; 57: 35-40) Key words: Long term prognosis, TAVR, Complications O ver the last several years we have been witnessing a substantial technical improvement and dynamic expansion of transcatheter aortic valve implantation (TAVI). Increasing operator experience and encouraging clinical outcomes data, revealing favorable results for TAVI in selected populations, have led to major changes in the management of patients with severe aortic stenosis (AS). In recent guidelines, TAVI has been recognized as an alternative method to surgical aortic valve replacement (SAVR) in high-risk patients and superior over conservative therapy in those disqualified from surgery. 1,2) Nevertheless, this procedure carries a substantial risk of numerous cardiovascular complications, among which the bleeding events are reported as the most frequent.3-7) Still, the body of evidence regarding the frequency of bleeding complications is relatively small, with significant differences in incidence between the studies, which is probably the result of differences in the applied methodology. [8][9][10] The clinical and procedural predictors of bleeding complications are not yet fully identified, and neither is their prognostic value. 3,7,8,10) Although the impact of bleeding on short-term mortality has been demonstrated, the influence on mid-term outcomes remains unclear. 11)To address the issue of heterogeneous reporting of out...

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“…Female gender and sheath size >19 French have been shown in several studies to increase risk. First, Van Mieghem et al showed that female gender was an independent predictor for complications (17). This study was a five-center study with 803 patients undergoing transfemoral approach.…”

Section: Risk Factors For Complicationsmentioning

confidence: 99%

Access site complications in transcutaneous aortic valve replacement: frequency, outcomes, prevention, and treatment

et al. 2018

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Aortic stenosis (AS) is a common cause of valvular heart disease with heavy disease burden in elderly patients. It is present in almost 7% of patients older than 65. The mortality rate increases significantly once it becomes symptomatic with average life expectancy of around 1-year. Symptoms include angina, syncope, or heart failure. This requires either surgical or transcutaneous replacement. Transcutaneous aortic valve replacement (TAVR) use has increased in recent years from high risk patients to now even including intermediate risk patients. With the increased number of procedures performed, one of the consequences is access site complications. These complications can lead to increased hospitalization, cost, infections, and eventually worse outcomes. In this manuscript, we provide a comprehensive review discussing the consequences, outcomes, frequency, predictors and some possible solutions to these complications set forth in these studies.

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Incidence, Predictors, and Implications of Access Site Complications With Transfemoral Transcatheter Aortic Valve Implantation

Cited by 221 publications

References 29 publications

Routine Endovascular Treatment With a Stent Graft for Access-Site and Access-Related Vascular Injury in Transfemoral Transcatheter Aortic Valve Implantation

Routine Endovascular Treatment With a Stent Graft for Access-Site and Access-Related Vascular Injury in Transfemoral Transcatheter Aortic Valve Implantation

Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation

Access site complications in transcutaneous aortic valve replacement: frequency, outcomes, prevention, and treatment

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