title: First experience with a new balloon-expandable and re-collapsible vascular sheath in transfemoral percutaneous aortic valve replacement.
abstract: OBJECTIVE
  To describe a novel method of transfemoral access via a first generation balloon-expandable and re-collapsible access system.
  
  
  METHODS
  In a patient at very high risk for surgical aortic valve replacement and with a relative contraindication for transapical transcatheter aortic valve implantation (TAVI) (left ventricular ejection fraction = 12%), transfemoral TAVI was performed. Due to compromising peripheral vascular anatomy/disease, a novel balloon-expandable and re-collapsible sheath system (Onset Medical, a subdivision of Terumo Medical Corporation, Irvine, CA) was used to achieve transfemoral access for the implantation of a 31-mm Medtronic CoreValve® prosthesis.
  
  
  RESULTS
  The sheath with an initial outer diameter of ~13 French was introduced via the right common femoral artery and advanced into the descending aorta without difficulties and expanded with a pressure of 20 atm for 60 sec. After successful transfemoral TAVI, the sheath was deflated to a size of ~13 French and removed from the vessel. A ProStar® closure device was successfully used to achieve hemostasis. Routine access-site angiography revealed no signs of dissection, stenosis, or extravasation. During the further clinical stay, no further major vascular complication or need for transfusion occurred. The patient was discharged on day 7 after the procedure.
  
  
  CONCLUSIONS
  The use of a balloon-expandable re-collapsible transfemoral sheath appears to be a promising approach with the potential of less vascular trauma. Further studies will need to evaluate the potential benefit of this novel device in patients with peripheral artery disease and if vascular injury and subsequent access site complications can hereby further be reduced.
authors: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany.
authors: Alexander
authors: A
authors: Sedaghat
authors: Jan-Malte
authors: JM
authors: Sinning
authors: Nikos
authors: N
authors: Werner
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000295:instrumentation*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D062906:Cardiac Catheters; D004867:Equipment Design; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015641:Radiography, Interventional; D016896:Treatment Outcome
keywords: TAVI; VARC; access site complication; percutaneous aortic valve replacement