Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access

Florence Leclercq (1, 2) , Mariama Akodad (1) , Jean-Christophe Macia (1) , Thomas Gandet (3) , Benoit Lattuca (1) , Laurent Schmutz (4) , Richard Gervasoni (1) , Erika Nogué (1) , Nicolas Nagot (1, 5) , Gilles Levy (6) , Eric Maupas (7) , Gabriel Robert (8) , Frederic Targosz (9) , Hélène Vernhet (1, 10) , Guillaume Cayla (4, 2) , Bernard Albat (3, 2)

1 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
2 UM - Université de Montpellier
3 Service de chirurgie thoracique et cardio-vasculaire
4 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
5 Pathogénèse et contrôle des infections chroniques (PCCI)
6 Clinique du Millénaire - Oc Santé [Montpellier]
7 Hôpital privé les Franciscaines
8 Clinique Saint Pierre, Perpignan
9 Centre Hospitalier Saint Jean de Perpignan
10 EA 2992 - Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires

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.

Domaines: Cardiologie et système cardiovasculaire

Florence Leclercq, Mariama Akodad, Jean-Christophe Macia, Thomas Gandet, Benoit Lattuca, et al.. Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access. American Journal of Cardiology, 2015, 116 (9), pp.1399 - 1404. ⟨10.1016/j.amjcard.2015.08.003⟩. ⟨hal-01912235⟩