title: Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access.
abstract: Major vascular complications (VC) remain frequent after transcatheter aortic valve implantation (TAVI) and may be associated with unfavorable clinical outcomes. The objective of this study was to evaluate the rate of VC after transfemoral TAVI performed using an exclusive open surgical access strategy. From 2010 to 2014, we included in a monocentric registry all consecutive patients who underwent transfemoral TAVI. The procedures were performed with 16Fr to 20Fr sheath systems. VC were evaluated within 30 days and classified as major or minor according to the Valve Academic Research Consortium 2 definition. The study included 396 patients, 218 were women (55%), median age was 85 years (81 to 88), and the median logistic Euroscore was 15.2% (11 to 23). The balloon-expandable SAPIEN XT and the self-expandable Medtronic Core Valve prosthesis were used in 288 (72.7%) and 108 patients (27.3%), respectively. The total length of the procedure was 68 ± 15 minutes including 13 ± 5 minutes for the open surgical access. Major and minor VC were observed in 9 (2.3%) and 16 patients (4%), respectively, whereas life-threatening and major bleeding concerned 18 patients (4.6%). The median duration of hospitalization was 5 days (interquartile range 2 to 7), significantly higher in patients with VC (7 days [5 to 15], p <0.001). Mortality at 1-month and 1-year follow-up (n = 26, 6.6%; and n = 67, 17.2%, respectively) was not related to major or minor VC (p = 0.6). In multivariable analysis, only diabetes (odds ratio 2.5, 95% confidence interval 1.1 to 6.1, p = 0.034) and chronic kidney failure (odds ratio 3.0, 95% confidence interval 1.0 to 9.0, p = 0.046) were predictive of VC, whereas body mass index, gender, Euroscore, and lower limb arteriopathy were not. In conclusion, minimal rate of VC and bleeding can be obtained after transfemoral TAVI performed using an exclusive surgical strategy, with a particular advantage observed in high-risk bleeding patients.
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France. Electronic address: f-leclercq@chu-montpellier.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: Leclercq
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Mariama
authors.initials: M
authors.lastname: Akodad
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Macia
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gandet
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lattuca
authors.affiliation: Department of Cardiology, University Hospital of Nimes, Nimes, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Schmutz
authors.affiliation: Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Gervasoni
authors.affiliation: Department of Medical Information, University Hospital of Montpellier, Montpellier, France.
authors.forename: Erika
authors.initials: E
authors.lastname: Nogue
authors.affiliation: Department of Medical Information, University Hospital of Montpellier, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nagot
authors.affiliation: Department of Cardiology, Clinique du Millenaire, Montpellier, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Levy
authors.affiliation: Department of Cardiology, Clinique des Franciscaines, Nîmes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Maupas
authors.affiliation: Department of Cardiology, Clinique St. Pierre, Perpignan, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Robert
authors.affiliation: Department of Cardiology, General Hospital of Perpignan, Perpignan, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Targosz
authors.affiliation: Department of Radiology, University Hospital of Montpellier, Montpellier, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Vernhet
authors.affiliation: Department of Cardiology, University Hospital of Nimes, Nimes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Montpellier, Montpellier, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Albat
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000401:mortality*; D016896:Treatment Outcome