title: Expandable sheath for transfemoral transcatheter aortic valve replacement: procedural outcomes and complications.
abstract: OBJECTIVE
  It is currently unknown whether the expandable sheath (e-sheath) for transfemoral Edwards transcatheter aortic valve replacement (TAVR) has a lower rate of access complications than the 18/19F fixed size sheath (f-sheath). Our aim was to compare the incidence of procedural complications when using f-sheath vs. e-sheath during TAVR.
  
  
  METHODS
  We included 162 consecutive patients, implanted with the Edwards SAPIEN XT valve in our center. Access closure was obtained with the Prostar system in all cases. E-sheath was used in 80 patients (49%).
  
  
  RESULTS
  Minimal ilio-femoral diameter was comparable in e-sheath and f-sheath groups: 6.7 (6.1-7.7) vs. 7 (6.2-8) mm, P = 0.25, as was the frequency of peripheral artery disease: 12.5% vs. 13.4%, P = 1.0. VARC major vascular complications rate was similar in the 2 groups: e-sheath 7 (8.8%) vs. f-sheath 6 (7.3%), P = 0.74, as was the incidence of minor vascular complications: 8 (10%) vs. 14 (17.1%), P = 0.19, life-threatening bleeding: 6 (7.5%) vs. 6 (7.3%), P = 0.96, major and minor bleeding and use of covered vascular stents: 9 (11%) vs. 6 (7.5%), P = 0.59.
  
  
  CONCLUSIONS
  The e-sheath for TAVR with the Edwards valve did not show an advantage over the f-sheath in reducing vascular and bleeding complications.
authors.affiliation: Department of Cardiology, Charles Nicolle University Hospital, INSERM U 1096, 1 rue de Germont, Rouen Cedex, 76031, France.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Borz
authors.forename: Eric
authors.initials: E
authors.lastname: Durand
authors.forename: Christophe
authors.initials: C
authors.lastname: Tron
authors.forename: Matthieu
authors.initials: M
authors.lastname: Godin
authors.forename: Alexandre
authors.initials: A
authors.lastname: Canville
authors.forename: Camille
authors.initials: C
authors.lastname: Hauville
authors.forename: Alain
authors.initials: A
authors.lastname: Cribier
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005268:Femoral Vein; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D011677:Punctures; D012307:Risk Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices
keywords: expandable sheath; transcatheter aortic valve replacement; vascular complication