Usefulness of a novel balloon-expandable vascular sheath for facilitated large-bore arterial access for transcatheter aortic valve implantation

Introduction Vascular access remains a major challenge in transfemoral transcatheter aortic valve implantation (TAVI) due to the need of large-bore introducer sheaths, ranging between 18 and 24 Fr inner diameter (outer diameter [OD] up to 28 Fr). The elderly patient population currently referred for TAVI often presents with advanced atherosclerosis of the iliofemoral axis. To accommodate the largebore sheath required for TAVI, balloon angioplasty with or without stenting may thus become necessary before sheath insertion. Nevertheless, dissections, occlusions or ruptures of the iliofemoral arteries, which are encountered in 13% up to 32% of patients, significantly contribute to periprocedural morbidity and mortality. In patients with diffusely calcified access vessels with diameters <7mm, transfemoral TAVI may not be possible and TAVI may be performed transapically or via the axillary artery, which, however, increases procedural complexity and requires general anaesthesia.