title: Vascular complications after transcatheter aortic valve implantation (TAVI): risk and long-term results.
abstract: Vascular complications are the main safety limitations of transcatheter aortic valve implantation (TAVI). The aim of the study was to assess the incidents, predictors, and the impact of early vascular complications on prognosis after TAVI. This was a single-center analysis of vascular complications related to TAVI. Early vascular complications were defined as incidents within 30 days after TAVI and comprised complications related to transvascular: transfemoral/transsubclavian ,and transapical bioprosthesis implantation. Evaluated risk factors were: (1) clinical characteristics, (2) TAVI route, and (3) center experience. In patients with transvascular TAVI the impact of: (1) diameters of access arteries, vascular sheathes and difference between them, (2) arterial wall calcification, and (3) ProStar devices used for access site closure were assessed. Arterial wall calcification and arteries diameters were measured by 64-slice computer tomography. Arterial wall calcification was graded according to 5° scale.
  
  
  RESULTS
  between 2009-2011; follow-up 1-23 months (12 ± 15.55), 83 consecutive patients, and 62-91 (81.10 ± 7.20) years, underwent TAVI: 67 (80.72%) patients had transvascular, and 16 (19.27%) patients had transapical bioprosthesis implantation. We noted 44 (53.01%) early vascular complications: 17 (20.48%) were major and 27 (32.53%) were minor incidents. Independent predictors of early vascular complications were: history of anaemia (OR 3.497: 95% CI [1.276-9.581]; p = 0.014), diabetes (OR 0.323: 95% CI [0.108-0.962]; p = 0.042), percutaneous coronary intervention performed as preparation for TAVI (OR 4.809: 95 % CI [1.172-19.736]; p = 0.029), and arterial wall calcification (OR 1.945: 95% CI [1.063-3.558]; p = 0.03). Of 6 (7.22%) in-hospital and 10 (12.98%) late deaths: 5 (83.33%) patients and 8 (80%) patients respectively had post-procedural vascular complications. Vascular complications, which occurred in 30-days after TAVI, predict late mortality (p = 0.036). Conclusions derived were: (1) TAVI patients with history of anaemia and diabetes required careful monitoring for early vascular complications. (2) If coronary intervention before TAVI is required, it should be performed in the time allowing vascular injuries to heal. (3) Calcification of access arteries is an independent predictor of post-procedural vascular complications; therefore, its estimation should be a regular element of preceding computer tomography. (4) Vascular complications seem to be predictors of late mortality after TAVI.
authors.affiliation: Department of Acquired Valvular Disease, Institute of Cardiology, Alpejska 42 Street, 04-628, Warsaw, Poland, kasia_czerwinska@vp.pl.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Czerwińska-Jelonkiewicz
authors.forename: Ilona
authors.initials: I
authors.lastname: Michałowska
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.forename: Maciej
authors.initials: M
authors.lastname: Dąbrowski
authors.forename: Ewa
authors.initials: E
authors.lastname: Księżycka-Majczyńska
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Chmielak
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kuśmierski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hryniewiecki
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
authors.forename: Janina
authors.initials: J
authors.lastname: Stępińska
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology