A new technique for vascular access management in transcatheter aortic valve implantation

Andrew S.P. Sharp, Iassen Michev, Francesco Maisano, Maurizio Taramasso, Cosmo Godino, Azeem Latib, Paulo Denti, Enrica Dorigo, Andrea Giacomini, Giuseppe Iaci, Mario Manca, Alfonso Ielasi, Matteo Montorfano, Ottavio Alfieri, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

109 Scopus citations

Abstract

Objectives: To describe results from a novel percutaneous technique designed to minimize the risk of hemorrhage in the event of a major complication during transcatheter aortic valve implantation. Background: Vascular access management is a major challenge in transfemoral TAVI due to the large introducer sheathes required. Methods: Fifty-two pts underwent TAVI between November 2007 and March 2009. Of these, 37 received an Edwards-Sapien Valve (23 mm valve: 17/37; 26 mm valve: 20/37) whilst 15 patients received a CoreValve (26 mm valve: 6/15; 29 mm valve: 9/15). Using a crossover technique, the opposing femoral artery was cannulated with a 7Fr long sheath. This allowed contralateral passage of a balloon and inflation in the proximal iliac. The sheath was then removed and Prostar sutures tied in a dry field. Balloon optimization of the puncture site was performed as required. Results: In three subjects, elective surgical repair was undertaken due to excessive femoral arterial calcification. In the remaining 49, the crossover technique was employed and closed with two Prostar devices (Edwards-Sapien) or one (CoreValve). There were serious "on-table" complications in seven patients, six due to the large introducer sheathes used in the TAVI procedure-iliac avulsion, two iliac dissections, iliac perforation, common femoral perforation and scrotal hematoma. All were repaired safely by combined surgical and endovascular techniques, using the crossover technique to ensure patient stability. All made a good recovery and were independently ambulant at discharge. Conclusion: Using crossover balloon inflation as an adjunct to Prostar closure may be helpful for managing TAVI vascular access sites.

Original languageEnglish (US)
Pages (from-to)784-793
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume75
Issue number5
DOIs
StatePublished - Apr 1 2010
Externally publishedYes

Keywords

  • Aortic valve
  • Closure devices
  • Percutaneous
  • TAVI
  • Vascular complications

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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