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Percutaneous aortic valve replacement: vascular outcomes with a fully percutaneous procedure
Stefan Toggweiler1, Ronen Gurvitch, Jonathon Leipsic
1Department of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
Journal of the American College of Cardiology
|January 7, 2012
Summary
Vascular complications after transfemoral percutaneous aortic valve replacement (PAVR) significantly decreased with improved patient selection and advanced techniques. Careful screening and percutaneous methods reduce risks, especially in patients with specific arterial conditions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Vascular complications are a primary concern in transfemoral percutaneous aortic valve replacement (PAVR).
- Both open surgical and fully percutaneous access strategies are employed for PAVR.
Purpose of the Study:
- To evaluate vascular complications following transfemoral PAVR.
- To assess complication rates using current Valve Academic Research Consortium definitions.
Main Methods:
- Prospective evaluation of 137 consecutive patients undergoing transfemoral PAVR.
- Assessment at baseline, post-procedure, and 30-day follow-up.
- Utilized percutaneous pre-closure techniques for arteriotomy, alongside advanced imaging and patient selection.
Main Results:
- Major vascular complications decreased from 8% to 1% (p=0.06) and minor complications from 24% to 8% (p<0.01) between 2009-2010.
- Major bleeds and unplanned surgeries also significantly reduced (p<0.01).
- Smaller artery diameter, severe calcification, and peripheral vascular disease were linked to higher complication rates.
Conclusions:
- Vascular complications are more frequent with smaller artery diameter, severe calcification, and peripheral vascular disease.
- Careful patient selection, advanced interventional techniques, and fully percutaneous procedures significantly reduce vascular and bleeding complications.
