Vascular complications with transcatheter aortic valve implantation using the 18 Fr Medtronic CoreValve System: the Rotterdam experience.
OBJECTIVE
Transcatheter aortic valve implantation (TAVI) requires large bore catheters. Access site complications, therefore, can be a concern. The aim of this study is to present the 30-day incidence of major and minor vascular complications in patients treated with the third generation 18 Fr Medtronic CoreValve System.


RESULTS
We prospectively evaluated the vascular complications occurring in all patients treated with the 18 Fr Medtronic CoreValve System between October 2006 and October 2009 in the Thoraxcenter using various proposed definitions. Ninety-nine consecutive patients were treated with TAVI using the 18 Fr Medtronic CoreValve System. Vascular events were encountered in 13 patients (13%), seven of these cases (54%) were related to incomplete arteriotomy closure with the Prostar device which is the default access closure technique in our centre. Depending on how major vascular complications were defined, the incidence varied from 4 to 13%. Blood transfusions in combination with surgical or percutaneous intervention were required in eight cases.


CONCLUSIONS
Transcatheter aortic valve implantation with the 18 Fr Medtronic CoreValve System(R) has a 4 to 13% vascular complications' rate. More than half of the vascular events were due to incomplete Prostar arteriotomy closure, despite its use by experienced operators. Current percutaneous closure devices for these large arteriotomies seems suboptimal. Uniformity in how to define TAVI related vascular complications is needed.
Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
Nicolas M
NM
Van Mieghem
Rutger-Jan
RJ
Nuis
Nicolo
N
Piazza
Tzikas
T
Apostolos
Jurgen
J
Ligthart
Carl
C
Schultz
Peter P
PP
de Jaegere
Patrick W
PW
Serruys
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology