title: The safety and efficacy of temporary distal aortic occlusion to facilitate TAVR large-bore arterial closure.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of temporary distal aortic occlusion (TDAO) for facilitated large-bore arterial closure during transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  Ipsilateral iliac artery occlusion and TDAO have been used to facilitate TAVR delivery sheath access-site closure, but ipsilateral iliac artery occlusion has been associated with arterial complications at the balloon site.
  
  
  METHODS
  TDAO was performed in 117 consecutive transfemoral TAVR cases from July 2010 to April 2012. The valve delivery access site was preclosed with suture-mediated closure devices (n = 100) or had a planned surgical cutdown performed (n = 17). TDAO was performed using a 22 mm x 5 cm Tyshak II balloon, which was deployed at the minimum pressure to stop antegrade blood flow in the distal abdominal aorta via a contralateral 8 Fr femoral sheath. This served to occlude iliac run-off as the TAVR delivery sheath access site was closed. Final aortogram with bilateral run-off was performed to evaluate for aortic, iliac, or femoral dissection or rupture, or ilio-femoral vascular complications in accordance with Valve Academic Research Consortium (VARC)-2 criteria.
  
  
  RESULTS
  TDAO was successfully performed in all patients with no complications related to the TDAO technique itself. There were vascular complications related to the TAVR procedure. 7 patients (6.0%) had VARC-2 major vascular complications and 16 patients (13.7%) had VARC-2 minor vascular complications.
  
  
  CONCLUSIONS
  TDAO is a safe and effective technique to facilitate large-bore arterial closure by both percutaneous and open surgical closure techniques.
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA. tworley@crsti.org.
authors.forename: Bruce
authors.initials: B
authors.lastname: Bowers
authors.forename: John
authors.initials: J
authors.lastname: Anderson
authors.forename: David
authors.initials: D
authors.lastname: Brown
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000503:physiopathology; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000293:injuries; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D012189:Retrospective Studies; D060205:Therapeutic Occlusion / Q000009:adverse effects / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control