21 TAVI implant without secondary arterial access: experience of a tertiary centre

Background Transcatheter aortic valve implantation (TAVI) carries a significant risk of vascular complications. Previous studies have found secondary access to account for 10–20% of total vascular complications.¹ We describe the use of ACCURATE NEO 2 TAVI valve combined with the iSLEEVE expandable introducer to facilitate single access TAVI implantation. Using the primary access, the pigtail catheter can be introduced to the non-coronary cusp (NCC) by a second puncture to the iSLEEVE's haemostatic valve. The pigtail catheter traditionally allows demarcation and subsequent conventional positioning of the valve in relation to NCC cusp height. We hypothesized the use of single access TAVI may involve significant operator learning curve and thus we describe our centre's experience of single access TAVI implantation. Methods We collected data on all patients who had undergone this single access TAVI procedure using ACCURATE NEO 2 between May 2023 and February 2024. We describe complexity of implant by describing volume of contrast used, dosage of radiation and screening time of patients. Additionally, we report complications and post-procedural valvular leak. Results 60 patients underwent attempted single access TAVI procedure: average age 81.6 (± 5.2), 33.3% women (n=20). Average radiation dose was 1192.1cGycm (±538.8), average contrast volume 122.2 ml (±42.8) and average total screening time 10.9 minutes (±3.0). There were 18 complications (30%): PPM (n=6, 10%), limb ischaemia (n=1, 1.7%), transient atrial flutter/fibrillation (n=2, 3.3%), new left bundle branch block (n=5, 8.3%), stroke (n=1, 1.7%), severe hypotension requiring inotropic support (n=1, 1.7%) and converted to dual access (n=2, 3.3%). No/trace valvular leak was observed in 49 patients (81.7%), mild leak in 7 patients (11.7%) and moderate leak in 4 patients (6.7%). Conclusion Our early experience of single access had similar procedure screen times, contrast volumes and radiation dose to previous observational data.² In our cohort, vascular complication rates were low, in keeping with the advantage of single access TAVI implantation. Where appropriate, our data shows single access TAVI with the ACCURATE NEO 2 device offers a safe approach without a significant operator learning curve. References Mach M, Okutucu S, Kerbel T, Arjomand A, Fatihoglu SG, Werner P, et al. Vascular complications in TAVR: incidence, clinical impact, and management. J Clin Med. 2021 Oct 28;10(21):5046. Sharma D, Ramsewak A, O'Conaire S, Manoharan G, Spence MS. Reducing radiation exposure during transcatheter aortic valve implantation (TAVI). Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2015 Jun;85(7):1256–61. Conflict of Interest None