Aorto-iliac angiography as a screening tool in selecting patients for transfemoral aortic valve implantation with the Edwards SAPIEN bioprosthesis.
OBJECTIVE
Transcatheter aortic valve replacement (TAVR) is a promising therapeutic option for patients with severe aortic stenosis (AS) considered at too high risk for conventional aortic valve replacement. The balloon-expandable Edwards valve can be implanted using either the transfemoral or transapical routes, depending on arterial ilio-femoral suitability. The aim of the study was to evaluate the usefulness of ilio-femoral angiography as an initial screening tool for TAVR using the transfemoral approach with the Edwards SAPIEN valve.


RESULTS
Aortography with bilateral ilio-femoral run-off was assessed in the antero-posterior projection. Minimal arterial diameter, vessel tortuosity and calcification were assessed. Transfemoral implantation was appropriate when the minimal arterial diameter was >7 mm for a 23 mm trans-catheter heart valve (THV) and >8 mm for a 26 mm THV with limited calcifications and tortuosity. Included were 135 patients with severe aortic stenosis undergoing cardiac catheterisation before conventional aortic valve replacement or TAVR. Mean femoral artery diameter was 7.5+/-1.3 mm and mean iliac artery diameter was 9.3+/-2.3 mm. There was no or moderate tortuosity in 72% of them. Calcifications were absent or moderate in 83%. At first sight, the transfemoral route was considered potentially suitable in 71% of patients for a 23 mm THV and 39% of patients for a 26 mm TAVI.


CONCLUSIONS
In the course of haemodynamic and angiographic evaluation of patients with severe symptomatic aortic stenosis, angiography of the ilio-femoral access can be used as a first screening modality to determine potential candidacy for a transfemoral TAVR using a balloon expandable THV.
Eltchaninoff
Helene
H
Department of Cardiology, INSERM U 644, Charles Nicolle University Hospital, University of Rouen, Rouen, France. Helene.Eltchaninoff@chu-rouen.fr
Kerkeni
Mehdi
M
Zajarias
Alan
A
Tron
Christophe
C
Godin
Matthieu
M
Sanchez Giron
Carlos
C
Baala
Brahim
B
Cribier
Alain
A
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D002302:Cardiac Output; D017023:Coronary Angiography; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D008297:Male; D018579:Patient Selection