title: Feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters.
abstract: OBJECTIVE
  We intended to show feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters.
  
  
  BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has emerged as a valid treatment option in patients with aortic valve stenosis who are poor candidates for surgical aortic valve replacement. Few patients, who cannot undergo transfemoral or transsubclavian aortic valve implantation due to small access vessel diameters, are not suitable for transapical or direct aortic valve implantation, either.
  
  
  METHODS
  In more than 700 transcatheter aortic valve implantations since 2008 we identified 17 patients who had to be excluded from transfemoral valve implantation due to vessel diameters <6 mm and who were no candidates for transapical or direct aortic implantation. We performed CoreValve™ implantations in these patients without the required 18F sheath to cross the vessels despite their small size (4.6-5.9 mm).
  
  
  RESULTS
  Sixteen sheathless implantations were successful. In all 17 patients, bleeding during the procedure due to the smaller delivery catheter was minimal. Sixteen patients had a successful access site closure at the end of the procedure.
  
  
  CONCLUSIONS
  Sheathless implantation of a self-expanding aortic valve can be safely considered in selected patients with access vessel diameters below 6 mm, if transapical or direct aortic implantation is not suitable.
authors.affiliation: Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Geis
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chorianopoulos
authors.forename: Klaus
authors.initials: K
authors.lastname: Kallenbach
authors.forename: Florian
authors.initials: F
authors.lastname: André
authors.forename: Sven T
authors.initials: ST
authors.lastname: Pleger
authors.forename: Matthias
authors.initials: M
authors.lastname: Karck
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.forename: Raffi
authors.initials: R
authors.lastname: Bekeredjian
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D062906:Cardiac Catheters; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D017755:Prosthesis Fitting / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D011859:Radiography; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome
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