title: Transfemoral aortic valve implantation new criteria to predict vascular complications.
abstract: OBJECTIVE
  This study sought to evaluate the incidence, impact, and predictors of vascular complications in transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Vascular complications increase morbidity and mortality in transfemoral TAVI; however, there remains a paucity of data describing these serious events.
  
  
  METHODS
  We performed a prospective cohort study of 130 consecutive transfemoral TAVI recipients. Vascular complications were defined by the Valve Academic Research Consortium (VARC) criteria. The ratio of the sheath outer diameter (in millimeters) to the minimal femoral artery diameter (in millimeters) defined the sheath to femoral artery ratio (SFAR).
  
  
  RESULTS
  In our cohort of elderly patients (83.3 ± 5.9 years), the logistic EuroScore was 25.8% ± 11.9%. The Edwards valve was used in 102 cases (18- to 24-F) and the CoreValve in 27 (18-F). The minimal femoral artery diameter was 8.17 ± 1.14 mm, and the calcification (0 to 3) and tortuosity scores (0 to 3) were 0.58 ± 0.72 and 0.28 ± 0.53, respectively. The mean sheath diameter was 8.10 ± 0.82 mm, and the mean SFAR was 0.99 ± 0.16. Vascular complications occurred in 27.6% (VARC major: 17.3%, minor: 10.2%), and major vascular complications predicted 30-day mortality (22.7% vs. 7.6%, p = 0.049). The SFAR (hazard ratio [HR]: 186.20, 95% confidence interval [CI]: 4.41 to 7,855.11), center experience (HR: 3.66, 95% CI: 1.17 to 11.49), and femoral calcification (HR: 3.44, 95% CI: 1.16 to 10.17) predicted major complications by multivariate analysis. An SFAR threshold of 1.05 (area under the curve = 0.727) predicted a higher rate of VARC major complications (30.9% vs. 6.9%, p = 0.001) and 30-day mortality (18.2% vs. 4.2%, p = 0.016).
  
  
  CONCLUSIONS
  Vascular complications in transfemoral TAVI are relatively frequent. VARC major vascular complications increase 30-day mortality and are predicted by experience, femoral calcification, and SFAR. Routine application of SFAR will improve patient selection for transfemoral TAVI and may improve outcome.
authors.affiliation: Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.forename: Bernard
authors.initials: B
authors.lastname: Chevalier
authors.forename: Thomas
authors.initials: T
authors.lastname: Hovasse
authors.forename: Mauro
authors.initials: M
authors.lastname: Romano
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.forename: Jhonathan
authors.initials: J
authors.lastname: Uribe
authors.forename: Arnaud
authors.initials: A
authors.lastname: Farge
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.forename: Erik
authors.initials: E
authors.lastname: Bouvier
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cormier
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D057785:Catheters; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005602:France; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D011474:Prosthesis Design; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy