Background
Transcatheter aortic valve replacement (TAVR) is preferably performed as a completely
percutaneous procedure via transfemoral access. Suture-mediated vascular closure devices
are deployed prior to sheath insertion (pre-closure). Inability to perform pre-closure
may necessitate surgical vascular repair of the femoral artery. Patients at increased
risk of vascular surgery complications may benefit from a percutaneous method for
achieving access site haemostasis. Stent graft implantation is commonly used for treating
access site injury following TAVR. This study assessed the feasibility of a strategy
of planned stent graft implantation within the femoral artery for achieving access
site haemostasis in patients undergoing transfemoral TAVR and in whom vascular pre-closure
was not possible.
Methods
A prospective institutional TAVR registry was retrospectively analysed and a cohort
of patients were identified who were selected for transfemoral valve delivery and
in whom pre-closure failed and access site haemostasis was achieved by stent graft
implantation.
Results
This strategy was used for achieving access site haemostasis in 11 patients (1.5%
of 744 patients undergoing transfemoral TAVR). These patients were considered to be
at increased risk of vascular surgery complications due to advanced age, frailty,
comorbidities, or immobility. Stent graft implantation achieved access site haemostasis
in all patients. During follow-up, 30-day mortality was zero, 1-year mortality was
27%, and none of the patients required additional vascular interventions.
Conclusion
The preliminary data suggest that planned stent graft implantation within the femoral
artery may achieve access site haemostasis and enable a totally percutaneous TAVR
procedure, despite failure to perform pre-closure with a suture-based vascular closure
device.
Keywords
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Article info
Publication history
Published online: October 01, 2021
Accepted:
September 9,
2021
Received in revised form:
July 27,
2021
Received:
May 15,
2021
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
