Iliofemoral artery predilation prior to transfemoral transcatheter aortic valve implantation in patients with aortic valve stenosis and advanced peripheral artery disease

Author:

Alvarez‐Covarrubias Hector A.12ORCID,Joner Michael13,Cassese Salvatore13ORCID,Warmbrunn Mairead1,Lutz Jannik1,Trenkwalder Teresa13,Seguchi Masaru1,Aytekin Alp1,Presch Antonia1,Pellegrini Constanza1,Rheude Tobias1,Patrick Mayr N.4ORCID,Kufner Sebastian13,Schunkert Heribert13,Kastrati Adnan13ORCID,Xhepa Erion13ORCID

Affiliation:

1. Department of Cardiology, Deutsches Herzzentrum München Technische Universität München Munich Germany

2. Hospital de Cardiología Centro Médico Nacional Siglo XXI, IMSS, Cd. de México Mexico City México

3. DZHK (German Center for Cardiovascular Research) Partner Site Munich Heart Alliance Munich Germany

4. Institut für Anästhesiologie, Deutsches Herzzentrum München Technische Universität München Munich Germany

Abstract

AbstractObjectivesTo investigate the feasibility and safety of percutaneous transluminal angioplasty (PTA) of the iliofemoral arteries (IFA) before transfemoral transcatheter aortic valve implantation (Tf‐TAVI) in patients with advanced peripheral artery disease (PAD).BackgroundAlthough Tf‐TAVI represents the access of choice, alternative vascular access routes are preferred for patients displaying advanced PAD. PTA of the IFA represents a less invasive option, broadening the spectrum of patients eligible for Tf‐TAVI.MethodsAll patients requiring PTA of the IFA before Tf‐TAVI, between 2012 and 2021, were included. Primary efficacy endpoint was the rate of successful transcatheter heart valve (THV) delivery and implantation. Primary safety endpoint was the rate of PTA and access‐site‐related vascular complications, procedural‐ and in‐hospital complications.ResultsAmong 2726 Tf‐TAVI procedures, 59 patients required IFA predilation. Successful THV delivery and implantation was achieved in 57 (96.6%) patients, respectively. Sheath placement was achieved in 59 (100%) patients with only one minor dissection and no major vascular complications following iliofemoral PTA. Regarding access site complications, two (3.4%) vessel perforations and one (1.7%) vessel rupture were observed, with eight (13.5%) patients requiring unplanned endovascular interventions. There was one intraprocedural death due to THV‐induced vessel laceration, while in‐hospital all‐cause mortality was 8.5% in the present high‐risk patient cohort.ConclusionsPredilation of IFA is safe and effective in patients with advanced PAD. Careful preprocedural planning is paramount in improving procedural safety and efficacy. This strategy has the potential to broaden the spectrum of patients eligible for Tf‐TAVI.

Publisher

Wiley

Subject

Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine

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