title: Incidence, predictors, and implications of access site complications with transfemoral transcatheter aortic valve implantation.
abstract: Our study objective was to assess the incidence, predictors, and implications of access site complications related to transfemoral transcatheter aortic valve implantation (TAVI). We pooled the prospective TAVI databases of 5 experienced centers in Europe enrolling only transfemoral cases for this analysis. Access site complications were defined according to the Valve Academic Research Consortium end-point definitions. The global transfemoral TAVI database contained 986 patients. Percutaneous access and closure was performed in 803 patients (81%) and a surgical strategy in 183 (19%). Incidences of major vascular complications, life-threatening/disabling bleeding, and major bleeding were 14.2%, 11%, and 17.8% respectively. In the patient cohort with a completely percutaneous access strategy, major vascular complications and life-threatening/disabling bleedings were related to closure device failure in 64% and 29%, respectively. Female gender (odds ratio 1.63, 95% confidence interval 1.12 to 2.36) and use of >19Fr system (2.87, 1.68 to 4.91) were independent predictors for major vascular complications. Female gender (odds ratio 2.04, 95% confidence interval 1.31 to 3.17), use of >19Fr system (1.86, 1.02 to 3.38), peripheral arterial disease (2.14, 1.27 to 3.61), learning effect (0.45, 0.27 to 0.73), and percutaneous access strategy (2.39, 1.16 to 4.89) were independently associated with life-threatening/disabling bleedings. In conclusion, transfemoral TAVI is associated with a >10% incidence of major vascular-related complications. A considerable number of these events is related to arteriotomy closure failure. Arterial sheath size and female gender are important determinants of major vascular complications and life-threatening/disabling bleeding.
authors: Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. n.vanmieghem@erasmusmc.nl
authors: Nicolas M
authors: NM
authors: Van Mieghem
authors: Didier
authors: D
authors: Tchetche
authors: Alaide
authors: A
authors: Chieffo
authors: Nicolas
authors: N
authors: Dumonteil
authors: David
authors: D
authors: Messika-Zeitoun
authors: Robert M A
authors: RM
authors: van der Boon
authors: Olivier
authors: O
authors: Vahdat
authors: Gill L
authors: GL
authors: Buchanan
authors: Bertrand
authors: B
authors: Marcheix
authors: Dominique
authors: D
authors: Himbert
authors: Patrick W
authors: PW
authors: Serruys
authors: Jean
authors: J
authors: Fajadet
authors: Antonio
authors: A
authors: Colombo
authors: Didier
authors: D
authors: Carrié
authors: Alec
authors: A
authors: Vahanian
authors: Peter P T
authors: PP
authors: de Jaegere
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; 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; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome; D014463:Ultrasonography; D062666:Vascular Access Devices / Q000009:adverse effects*; D014652:Vascular Diseases / Q000453:epidemiology* / Q000209:etiology