Transfemoral implantation of the ACURATE neo prosthesis using a low-profile expandable introducer system: A...

The ACURATE neo prosthesis is commonly implanted using introducer sheaths with inner diameters of up to 20 French. The use of only the expandable mesh component of the transGlide introducer system (Mesh_only) would substantially decrease the inner diameter to 13 French. We sought to assess the feasibility and safety of using Mesh_only for femoral access of the ACURATE neo device and to compare outcomes with patients in whom standard sheaths were used.

We retrospectively analyzed a total of 551 patients with severe aortic stenosis from 4 high volume centers in Germany and Switzerland undergoing transfemoral TAVI between February 2016 and February 2018 with implantation of the ACURATE neo device. The median age was 81.7 [78.3-85.2], 67.0% were female, the STS score was 4.2% [2.8-6.5]. The use of the Mesh_only was feasible in all attempted cases (n = 272); in all other patients, a standard sheath was used. Major vascular complications at the main access-site (VARC-2) were less frequent in the Mesh_only group than in the standard sheath group (1.5% vs. 7.9%; p < 0.001). In the multivariable analysis, the use of Mesh_only was independently associated with less major vascular complications (odds ratio 0.10 [95% CI 0.02-0.48]; p = 0.004).

Transfemoral implantation of the ACURATE neo device using the Mesh_only was associated with a lower rate of major access-related complications when compared to the standard of care.