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Published on: June 3, 2018
Anatomical Predictors of Access-Related Vascular Complications Following Transfemoral Transcatheter Aortic Valve
Gökhan Demirci1, Serkan Aslan1, Ahmet Anıl Şahin2
1Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Insights
Vascular complications after transfemoral transcatheter aortic valve replacement (TAVR) are a challenge. The common femoral artery depth-to-diameter ratio is a superior predictor of these complications compared to sheath-to-femoral artery ratio.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- Access-related vascular complications (VCs) following transfemoral transcatheter aortic valve replacement (TAVR) are linked to adverse clinical outcomes.
- Despite technological advancements, VCs remain a significant challenge in TAVR procedures.
Purpose of the Study:
- To identify anatomical predictors of access-related VCs after TAVR using preprocedural contrast-enhanced multidetector computed tomography (MDCT).
Main Methods:
- Retrospective analysis of 348 patients undergoing transfemoral TAVR.
- VCs were classified as minor or major per Valve Academic Research Consortium-3 (VARC-3) criteria.
- Statistical analysis, including regression and ROC curves, was performed to identify predictors.
Main Results:
- 29% of patients developed VCs (8.7% major, 20.3% minor).
- Significant predictors included severe common femoral artery (CFA) calcification, CFA depth, minimum CFA diameter, CFA depth-to-diameter ratio (≥5.6), and sheath-to-femoral artery ratio (SFAR).
- The CFA depth-to-diameter ratio demonstrated superior predictive performance (AUC 0.720) compared to SFAR (AUC 0.636).
Conclusions:
- Vascular access site complications are a concern in transfemoral TAVR.
- The CFA depth-to-diameter ratio shows better predictive value for VCs than SFAR.
- This ratio can improve risk stratification for VCs in high-risk patients, potentially reducing morbidity and mortality.
Background:
Access-related vascular complications (VCs) after percutaneous transfemoral transcatheter aortic valve replacement (TAVR) are associated with poor clinical outcomes and remain a significant challenge despite technological advances. The aim of this study was to identify anatomic predictors of access-related VCs after TAVR on preprocedural contrast-enhanced multidetector computed tomography (MDCT).
Aims:
The aim of this study was to identify anatomical predictors of access-related VCs after TAVR on preprocedural contrast-enhanced MDCT.
Methods:
A total of 348 consecutive patients with symptomatic severe AS who underwent transfemoral TAVR were included retrospectively. The primary endpoint of the study was the composite of minor and major access site complications as defined by the Valve Academic Research Consortium-3 (VARC-3) criteria. The study population was divided into two groups according to the VC including VC (+) and VC (-).
Results:
A total of 101 patients (29%) developed VC (8.7% major, 20.3% minor) following TAVR. Regression analysis identified severe CFA calcification (p = 0.004), CFA depth (p < 0.001), minimum CFA diameter (p < 0.001), CFA depth-to-diameter ratio ≥ 5.6 (p < 0.001), and sheath-to-femoral artery ratio (SFAR) (p < 0.001) as significant predictors of VC. ROC curves generated for the occurrence of VC, the AUC for the femoral artery depth-to-diameter ratio (0.720) was higher than the AUC for the SFAR and the depth of the femoral artery (0.636, 0.630).
Conclusion:
Complications related to vascular access sites continue to be a significant concern for patients undergoing TF-TAVR. The CFA depth-to-diameter ratio has demonstrated superior predictive performance for VC compared to SFAR as expressed in the literature. Utilizing this criterion may enhance risk stratification for VC in high-risk patients, potentially reducing associated morbidity and mortality.
