Impact of low-profile sheaths on vascular complications during transfemoral transcatheter aortic valve replacement.
Impact of low-profile sheaths on vascular complications during transfemoral transcatheter aortic valve replacement.
AIMS: We sought to assess the impact of low-profile sheaths on vascular complications during transfemoral transcatheter aortic valve replacement (TAVR). CONCLUSIONS: The introduction of lower-profile sheaths has dramatically reduced the incidence of vascular complications after transfemoral TAVR, thus enhancing the safety of the procedure. METHODS AND RESULTS: This retrospective single-study population comprised a total of 375 consecutive patients with severe aortic stenosis who underwent transfemoral TAVR from January 2008 to November 2012. Of these, 204 (54.4%) underwent TAVR using 14-18 Fr sheaths (low-profile sheath [LPS] group), and 171 (45.6%) using 19-24 Fr sheaths (high-profile sheath [HPS] group). Vascular complications and bleeding were defined according to the VARC-2 definitions. Lower-profile sheaths were associated with a lower incidence of major vascular complications (0.5% vs. 10.5%, p<0.001), as well as a lower rate of life-threatening or major bleeding (3.4% vs. 8.3%, p=0.038). Finally, at multivariable analysis, sheath size >19 Fr (adjusted odds ratio [OR]: 3.06, 95% confidence interval [CI]: 1.20-7.83; p=0.019) and a sheath external diameter/minimal femoral artery diameter ratio >1.05 (adjusted OR: 5.79, 95% CI: 1.29-15.92, p=0.022) were found to be the only independent predictors of major and minor vascular complications.
English
1774-024X
*Aortic Valve Stenosis/su [Surgery]
*Aortic Valve/su [Surgery]
*Cardiac Catheterization/ae [Adverse Effects]
*Femoral Artery/su [Surgery]
*Heart Valve Prosthesis Implantation
*Heart Valve Prosthesis/ae [Adverse Effects]
Aged
Aged, 80 and over
Female
Heart Valve Prosthesis Implantation/mt [Methods]
Humans
Male
Retrospective Studies
Treatment Outcome
MedStar Heart & Vascular Institute
Journal Article
AIMS: We sought to assess the impact of low-profile sheaths on vascular complications during transfemoral transcatheter aortic valve replacement (TAVR). CONCLUSIONS: The introduction of lower-profile sheaths has dramatically reduced the incidence of vascular complications after transfemoral TAVR, thus enhancing the safety of the procedure. METHODS AND RESULTS: This retrospective single-study population comprised a total of 375 consecutive patients with severe aortic stenosis who underwent transfemoral TAVR from January 2008 to November 2012. Of these, 204 (54.4%) underwent TAVR using 14-18 Fr sheaths (low-profile sheath [LPS] group), and 171 (45.6%) using 19-24 Fr sheaths (high-profile sheath [HPS] group). Vascular complications and bleeding were defined according to the VARC-2 definitions. Lower-profile sheaths were associated with a lower incidence of major vascular complications (0.5% vs. 10.5%, p<0.001), as well as a lower rate of life-threatening or major bleeding (3.4% vs. 8.3%, p=0.038). Finally, at multivariable analysis, sheath size >19 Fr (adjusted odds ratio [OR]: 3.06, 95% confidence interval [CI]: 1.20-7.83; p=0.019) and a sheath external diameter/minimal femoral artery diameter ratio >1.05 (adjusted OR: 5.79, 95% CI: 1.29-15.92, p=0.022) were found to be the only independent predictors of major and minor vascular complications.
English
1774-024X
*Aortic Valve Stenosis/su [Surgery]
*Aortic Valve/su [Surgery]
*Cardiac Catheterization/ae [Adverse Effects]
*Femoral Artery/su [Surgery]
*Heart Valve Prosthesis Implantation
*Heart Valve Prosthesis/ae [Adverse Effects]
Aged
Aged, 80 and over
Female
Heart Valve Prosthesis Implantation/mt [Methods]
Humans
Male
Retrospective Studies
Treatment Outcome
MedStar Heart & Vascular Institute
Journal Article