Peripheral access size evaluation in transfemoral transcatheter aortic valve replacement

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Vascular Medicine

Background:

• Peripheral access vessel dimensions are crucial for transcatheter aortic valve replacement (TAVR) procedures.
• Assessing these dimensions can inform the necessity of pre-TAVR computed tomography angiography (CTA).

Purpose of the Study:

• To determine peripheral access vessel sizes in patients screened for TAVR.
• To identify patient characteristics associated with these vessel dimensions.

Main Methods:

• Retrospective review of 1049 patients screened for TAVR (April 2012-March 2019).
• Contrast-enhanced CTA used to measure minimal luminal diameters (MLDs) of transfemoral access vessels.
• Statistical analyses included t-tests and regression to identify factors associated with MLD.

Main Results:

• Mean femoral artery MLDs were 7.73 mm (right) and 7.68 mm (left).
• Male sex and higher BMI were associated with larger MLDs.
• Conditions like peripheral vascular disease, hypertension, and smoking were inversely associated with MLD.

Conclusions:

• Most TAVR-screened patients possess peripheral vessel sizes adequate for current transcatheter heart valves.
• Clinical judgment of patient risk factors is essential for deciding on pre-TAVR CTA.
• Further research, including randomized controlled trials, is needed to compare outcomes with and without preoperative CTA.