title: Impact of low-profile sheaths on vascular complications during transfemoral transcatheter aortic valve replacement.
abstract: OBJECTIVE
  We sought to assess the impact of low-profile sheaths on vascular complications during transfemoral transcatheter aortic valve replacement (TAVR).
  
  
  RESULTS
  This retrospective single-study population comprised a total of 375 consecutive patients with severe aortic stenosis who underwent transfemoral TAVR from January 2008 to November 2012. Of these, 204 (54.4%) underwent TAVR using 14-18 Fr sheaths (low-profile sheath [LPS] group), and 171 (45.6%) using 19-24 Fr sheaths (high-profile sheath [HPS] group). Vascular complications and bleeding were defined according to the VARC-2 definitions. Lower-profile sheaths were associated with a lower incidence of major vascular complications (0.5% vs. 10.5%, p<0.001), as well as a lower rate of life-threatening or major bleeding (3.4% vs. 8.3%, p=0.038). Finally, at multivariable analysis, sheath size ≥19 Fr (adjusted odds ratio [OR]: 3.06, 95% confidence interval [CI]: 1.20-7.83; p=0.019) and a sheath external diameter/minimal femoral artery diameter ratio ≥1.05 (adjusted OR: 5.79, 95% CI: 1.29-15.92, p=0.022) were found to be the only independent predictors of major and minor vascular complications.
  
  
  CONCLUSIONS
  The introduction of lower-profile sheaths has dramatically reduced the incidence of vascular complications after transfemoral TAVR, thus enhancing the safety of the procedure.
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Binder
authors.forename: Melanie
authors.initials: M
authors.lastname: Freeman
authors.forename: David A
authors.initials: DA
authors.lastname: Wood
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.forename: John
authors.initials: J
authors.lastname: Tan
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yang
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.forename: Kasia
authors.initials: K
authors.lastname: Maryniak
authors.forename: Sandra
authors.initials: S
authors.lastname: Lauck
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome