Access site related vascular complications with third generation transcatheter heart valve systems

Ruge, Hendrik; Burri, Melchior; Erlebach, Magdalena; Lange, Rüediger

doi:10.1002/ccd.29095

Cited by 26 publications

(40 citation statements)

References 17 publications

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“…As these patients required more often a nontransfemoral access, 3/42 patients (7%) experienced accessrelated bleeding complications (one transfemoral, one transapical, and one transaortic access). Third generation THV delivery systems presenting with reduced sheath dimensions, allow a transfemoral access even in small or moderately calcified access vessels [Ruge 2020], perhaps reducing complication rates and improving the outcome of ESRD patients.…”

Section: Discussionmentioning

confidence: 99%

TAVR in Patients on Hemodialysis: Outcome of A High-Risk Patient Group

Ruge

Deutsch

Erlebach

et al. 2020

HSF

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Background: Perioperative mortality is high and long-term survival is poor for patients on hemodialysis undergoing surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) offers a safe and effective therapy for high-risk patients suffering from aortic valve stenosis. However, in patients on hemodialysis only limited information is available on the outcome following TAVR. Methods: Of the 2613 consecutive patients in our single-center TAVR registry, all hemodialysis patients, were identified. Demographics, procedural details, clinical outcomes, mortality, and complications were evaluated. Results: Forty-two hemodialysis patients with a mean age of 75.2±8.2 years, a mean STS predicted risk of mortality of 11.1±9.5% and a mean logEuroScore of 27.9±18.8% underwent TAVR. Mean duration on hemodialysis prior to intervention was 62.8±49.6 months. A transfemoral access was chosen in 24 patients, a transapical in 16, and a transaxillary and a transaortic in one patient, respectively. Estimated survival at 30 days, one, three and five years was 83.3%, 68.3%, 37.7% and 18.9%, respectively. Estimated median survival was 1.8±0.4 years. VARC-2 defined perioperative complications included stroke in 7.1% (3/42), major bleeding in 16.7% (7/42), and vascular complications in 7.1% (3/42). In two patients, echocardiographic examination at three and four years, respectively, showed evidence for structural valve deterioration. Conclusion: A high number of patients with ESRD undergoing TAVR require a non-transfemoral access. Predominantly, bleeding events contribute to the perioperative morbidity. An estimated median survival of less than two years after TAVR allows only limited assessment of valve prosthesis durability. Cardiovascular and non-cardiovascular mortality contribute equally to the causes of death beyond the first year after TAVR.

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Section: Discussionmentioning

confidence: 99%

TAVR in Patients on Hemodialysis: Outcome of A High-Risk Patient Group

Ruge

Deutsch

Erlebach

et al. 2020

HSF

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“…Vascular complications still represent a relevant concern in TAVI procedures. In intermediate risk patients, major vascular complications (MVC) with third-generation transcatheter heart valves (THV) have an incidence ranging from 6% to 7.9% [52] and are associated with worse clinical outcomes with a prolonged hospital stay, an increased risk of wound infection, and a higher in-hospital mortality [53] . A recent subanalysis from the WIN TAVI registry has outlined that women experiencing MVC after TAVR are at significantly higher early risk of life-threatening or major bleeding and death and late risk of stroke, confirming the importance of careful access site management in female patients undergoing TAVI (In press).…”

Section: Access Managementmentioning

confidence: 99%

TAVI specific sex consideration

Masiero¹,

Paradies²,

Franzone³

et al. 2022

MIS

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The impact of sex on baseline characteristics and morphological and clinical presentation of degenerative aortic stenosis has been widely demonstrated but poorly understood. Moreover, differently from valve surgery, where patients were predominantly male, both sexes have been well represented in percutaneous treatment of aortic stenosis (AS), and women appeared to derive greater benefit with transfemoral aortic valve implantation (TAVI) compared to surgical treatment. This review focuses on sex-specific differences in epidemiology, pathophysiology, diagnostic issues, treatment options, and clinical outcomes of degenerative AS. Moreover, we evaluate how sex-based TAVI management, from device selection to procedural tricks, may affect outcomes.

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“…In particular, circumferential calcifications may (a) interfere with adequate vessel puncture, (b) compromise sheath or device passage, and (c) increase the risk of major vascular complications such as dissection, bleeding and plaque disruption with acute limb ischemia (15) (Figure 1). In addition, anterior, posterior and especially circumferential calcification of the femoral artery reduces the efficacy of percutaneous suture-based closure devices (16). Strategies such as balloon angioplasty using the contralateral femoral artery as well as intravascular lithotripsy have been suggested to expand TF access to a subgroup of patients with significant PAD (17,18).…”

Section: Severe Peripheral Artery Diseasementioning

confidence: 99%

Challenging Anatomies for TAVR—Bicuspid and Beyond

Saad

Seoudy

Frank

2021

Front. Cardiovasc. Med.

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Transcatheter aortic valve replacement has emerged as the standard treatment for the majority of patients with symptomatic aortic stenosis. As transcatheter aortic valve replacement expands to patients across all risk groups, optimal patient selection strategies and device implantation techniques become increasingly important. A significant number of patients referred for transcatheter aortic valve replacement present with challenging anatomies and clinical indications that had been historically considered a contraindication for transcatheter aortic valve replacement. This article aims to highlight and discuss some of the potential obstacles that are encountered in clinical practice with a particular emphasis on bicuspid aortic valve disease.

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Access site related vascular complications with third generation transcatheter heart valve systems

Cited by 26 publications

References 17 publications

TAVR in Patients on Hemodialysis: Outcome of A High-Risk Patient Group

TAVR in Patients on Hemodialysis: Outcome of A High-Risk Patient Group

TAVI specific sex consideration

Challenging Anatomies for TAVR—Bicuspid and Beyond

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