title: Predictive factors of vascular complications after transcatheter aortic valve implantation in patients treated with a default percutaneous strategy.
abstract: BACKGROUND
  Percutaneous approach techniques with closure device after transcatheter aortic valve implantation (TAVI) have diminished vascular complications (VC). In this retrospective study, we will report incidence and angiographic factors predisposing to major VC in patients undergoing TAVI using Prostar® XL closure device as a default strategy.
  
  
  METHODS
  Consecutive patients, who underwent TAVI transfemorally using Prostar® XL, were evaluated for the incidence of VC according to VARC criteria. Using arterial angiography, the femoral-iliac arterial tortuosity was adjusted for large arterial diameters and expressed as the ratio total tortuosity/arterial diameter (TT/AD). Arterial calcification, the combination of angulation and atheromatosis at the puncture site and ideal puncture were evaluated too. In all patients, 30 days of follow-up was available.
  
  
  RESULTS
  Eighty-four patients (80.2 ± 5.86 years, 39 males [46.4%]), who were consecutively treated with the transfemoral approach, were evaluated. In patients with major VC (17/84 [20.23%]) comparing to those without, arterial calcification (11 [64.7%] vs. 8 [11.9%], P < 0.01) and the TT/AD (30.2 ± 11.25 vs. 22.06 ± 8.64, P < 0.01) were independent predictors. Ideal puncture was achieved more frequently among patients without VC comparing to those with major (94.1% vs. 70.6%, P = 0.01). Blood transfusions (1.48 ± 0.37 vs. 2.45 ± 0.59, P = 0.023) were more frequent among patients with major VC. Finally, minimum creatinin clearance after TAVI predicted all-cause 30-day mortality (P = 0.021).
  
  
  CONCLUSIONS
  Major VC after TAVI with the use of Prostar closure device can be predicted by arterial calcification at the puncture site and TT/AD ratio. Minimum creatinin clearance after TAVI predicted 30-day mortality.
authors.affiliation: 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece.
authors.forename: Manolis
authors.initials: M
authors.lastname: Vavuranakis
authors.forename: Maria
authors.initials: M
authors.lastname: Kariori
authors.forename: Vassilis
authors.initials: V
authors.lastname: Voudris
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kalogeras
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Vrachatis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Aznaouridis
authors.forename: Carmen
authors.initials: C
authors.lastname: Moldovan
authors.forename: Constantina
authors.initials: C
authors.lastname: Masoura
authors.forename: Sophia
authors.initials: S
authors.lastname: Thomopoulou
authors.forename: Georgios
authors.initials: G
authors.lastname: Lazaros
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006328:Cardiac Catheterization; D005260:Female; D005263:Femoral Artery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D015607:Stents; D061205:Vascular Calcification / Q000209:etiology
keywords: Prostar closure device; TAVI; predictive factors; vascular complications