Minimizing vascular complications of TAVI

Minimizing vascular complications of TAVI

Minimizing vascular complications of TAVI: Trancatheter aortic valve implantation (TAVI) or percutaneous aortic valve replacement is a fast developing modality for management of aortic stenosis, especially those unfit for surgical replacement. Though multiple approaches have been used, the most commonly used are the transapical and transfemoral routes. Transfemoral route is a purely percutaneous technique and is becoming more popular. Due to the large diameters of the hardware, vascular access site complications are a concern with fully percutaneous aortic valve replacement. Toggweiler S and associates have tried to analyze the determinants of vascular complications in this setting and the improvement over time [Percutaneous Aortic Valve Replacement. Vascular Outcomes With a Fully Percutaneous Procedure. J Am Coll Cardiol, 2012; 59:113-118]. Over one hundred and thirty five patients underwent the procedure during 2009-2010.

Planned arteriotomy closure with percutaneous pre-closure technique was used in all but one of the patients. Smaller sheaths, rigorous angiographic and computed tomographic (CT) screening and patient selection were used. They could achieve a reduction in major vascular complications from eight percent to one percent over this period. Minor vascular complication decrease from twenty four percent to eight percent. Major bleeds declined markedly from fourteen percent to just one percent (p<0.01). They noted that complications were more likely if the minimal diameter of the artery was smaller than the external sheath diameter. This was more so if the there was peripheral vascular disease and moderate or severe vascular calcification.