title: Predictors and incidence of access site complications in transcatheter aortic valve implantation with the use of new delivery systems.
abstract: OBJECTIVE
  The aim of this single-center study was to assess the incidence and predictors of in-hospital access site complications related to transcatheter aortic valve implantation (TAVI) performed with new delivery systems in our hospital which has the largest case series in Turkey.
  
  
  METHODS
  We performed successful TAVI with the Edwards Sapien XT valve to 127 (46 male) patients via a transfemoral (121), trans-subclavian (5) and transapical (1) approach. Access site complications were defined according to the Valve Academic Research Consortium (VARC) end-point definitions.
  
  
  RESULTS
  Vascular complications occurred in 10.1% of patients. There was negative correlation between vascular complications and diameter of the common femoral artery (r = - 0.301, p=0.004), external iliac artery (r = - 0.327, p=0.004) and common iliac artery (r = - 0.324, p=0.004), but positive correlation between diabetes (r =0.240, p=0.008), sheath to femoral artery ratio (SFAR), sheath to external iliac artery ratio (SEIAR), procedure time, discharge time and the Society of Thoracic Surgeons (STS) score (respectively; r=0.339, 0.001, 0.527, 0.361, 0.289, p=0.003, 0.001, 0.001, 0.001, 0.002). The incidence of vascular complications was significantly higher in patients with diabetes and a high STS score. VARC bleeding complications occurred in 11.7 % of patients. The learning curve pointing out the importance of experience was significantly important in decreasing both bleeding and vascular complications.
  
  
  CONCLUSIONS
  In this study, we demonstrated that major vascular complications related to TAVI decrease with the use of smaller delivery systems and experience and increase with high-risk scores (STS) and the presence of diabetes. In addition, VARC major vascular complications, observed mostly in patients with diabete mellitus (DM) and high STS scores, were associated with vascular diameters. These results further underline the importance of experience and a multidisciplinary team in patient selection and management for TAVI.
authors: Department of Cardiology, Ataturk Research and Training Hospital, Ankara, Turkey cengaver61@yahoo.com.
authors: C
authors: C
authors: Sari
authors: Cardiology Department, Yıldırım Beyazıt University, Ankara, Turkey.
authors: H
authors: H
authors: Ayhan
authors: Department of Cardiology, Ataturk Research and Training Hospital, Ankara, Turkey.
authors: A N
authors: AN
authors: Aslan
authors: Cardiology Department, Yıldırım Beyazıt University, Ankara, Turkey.
authors: T
authors: T
authors: Durmaz
authors: Cardiology Department, Yıldırım Beyazıt University, Ankara, Turkey.
authors: T
authors: T
authors: Keleş
authors: Department of Cardiology, Ataturk Research and Training Hospital, Ankara, Turkey.
authors: S
authors: S
authors: Baştuğ
authors: Cardiology Department, Yıldırım Beyazıt University, Ankara, Turkey.
authors: N Akar
authors: NA
authors: Bayram
authors: Department of Cardiology, Ataturk Research and Training Hospital, Ankara, Turkey.
authors: E
authors: E
authors: Bilen
authors: Cardiology Department, Yıldırım Beyazıt University, Ankara, Turkey.
authors: H A
authors: HA
authors: Kasapkara
authors: Cardiology Department, Yıldırım Beyazıt University, Ankara, Turkey.
authors: E
authors: E
authors: Bozkurt
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011183:Postoperative Complications; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D014652:Vascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology
keywords: bleeding complication; transcatheter aortic valve implantation; vascular complication