title: Transcatheter aortic valve implantation: is anatomy still the limiting factor?
abstract: BACKGROUND
  Despite rapid advances in transcatheter aortic valve prostheses, anatomical constraints remain that can limit access to this treatment for patients with severe aortic stenosis. The objective of this study was to determine the proportion of patients anatomically suitable for this technique using the different devices and approaches available.
  
  
  METHODS
  We retrospectively analyzed 145 consecutive patients referred to our center for transcatheter aortic valve implantation. Aortic annulus diameter was measured by transesophageal echocardiography and minimum iliofemoral diameter was determined by multidetector computed tomography. We determined the proportion of patients anatomically suitable for current devices (26-mm, 29-mm and 31-mm Medtronic CoreValve for transfemoral, transaxillary or transaortic approaches, and 23-mm, 26-mm and 29-mm Edwards Sapien XT for transfemoral or transapical approaches).
  
  
  RESULTS
  The Medtronic CoreValve was suitable for 89% of patients via transfemoral access and 93.8% via transaxillary or transaortic approaches, while the Edwards Sapien XT was suitable for 82.1% of patients via transfemoral and 97.2% via transapical approaches. Only 1.4% of patients were anatomically unsuitable for all devices and approaches.
  
  
  CONCLUSIONS
  In this population, most patients were anatomically suitable for transcatheter aortic valve implantation if assessed on the basis of multiple devices and multiple access approaches.
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. olga-sousa@sapo.pt
authors.forename: Olga
authors.initials: O
authors.lastname: Sousa
authors.forename: Marta
authors.initials: M
authors.lastname: Ponte
authors.forename: Daniel
authors.initials: D
authors.lastname: Caeiro
authors.forename: Mónica
authors.initials: M
authors.lastname: Carvalho
authors.forename: Daniel
authors.initials: D
authors.lastname: Leite
authors.forename: João
authors.initials: J
authors.lastname: Rocha
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.forename: José
authors.initials: J
authors.lastname: Ribeiro
authors.forename: Pedro
authors.initials: P
authors.lastname: Braga
authors.forename: Vasco
authors.initials: V
authors.lastname: Gama
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000601:surgery*; D002404:Catheterization; D005260:Female; D005263:Femoral Artery / Q000033:anatomy & histology*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology*; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies