P6336TAVI with a single femoral approach: preliminary single-centre experience

Abstract

BACKGROUND: To describe our initial experience with the transradial approach as secondary access site in TAVI. METHODS: As of April 2016, a strategy of systematic transradial approach as secondary access site for TAVI was adopted in our centre. A 5 F 125 cm multipurpose catheter was navigated from the left or right radial artery into the common iliac artery to assist in main access puncture. The catheter was then exchanged for a pigtail, which was positioned on the aortic valve to guide TAVI. The multipurpose catheter was used again at the end of the procedure to assess ilio-femoral integrity. In case of an iliac or femoral access complication, the radial sheath was exchanged for a 120 cm long 5F sheath. A 0.018'/400 cm nitinol guidewire was introduced beyond the lesion and a compatible long shaft (180 cm) 5F balloon or nitinol self-expandable stent was introduced and used accordingly. In case of a perforation, a balloon was inflated proximal to the lesion in order to stop the bleeding and contralateral femoral access was obtained in order to deploy a covered stent via a 6F sheath. RESULTS: From April 2016, 184 patients underwent TAVI using this strategy. Patients had a mean age of 83±5.9 years, 52.2% were male, mean Logistic Euroscore and STS score were 16.5±11.6% and 5.3±4.7%, respectively. 97 (52.7%) patients received a balloon-expandable valve and 87 (47.3%) received a self-expandable valve. Transradial access as secondary approach was not used in 30 of 184 patients (16.3%) for the following reasons: absence of radial pulse or unsuitable artery size (n=14; 7.6%), prohibitive patient height (n=1; 0.8%), physician preference n=15; 8.1%). TAVI was successful in all cases. No complications occurred due to transradial access. Transfemoral vascular access site complications occurred in 8 cases (4.3 %): three occlusion, two flow-limiting stenoses and three perforations of the common femoral artery. Five complications were successfully managed using self-expanding stents from the transradial access. The 3 cases of perforation (1.6%) were successfully treated with a covered stent delivered via femoral crossover. There were no additional major vascular complications at 30 days. CONCLUSION: Use of the radial approach for secondary access in TAVI is safe and feasible. Most primary access site complications were manageable from the radial access site. A low rate of crossover to the contralateral femoral approach (1.6 %) was necessary. Further large-scale studies are necessary to confirm the benefits of this approach.