August 4, 2009
View Full PaperA new technique for vascular access management in transcatheter aortic valve implantation
Key Result
A crossover balloon inflation technique as an adjunct to Prostar closure during TAVI allowed safe management of vascular access sites, including successful repair of 7 serious complications.
Study Design
Type
Observational (n=52)
Structured PICO
Does a crossover balloon inflation technique improve vascular access management and safety during TAVI?
P
Population
52 patients undergoing transcatheter aortic valve implantation (TAVI) between November 2007 and March 2009
I
Intervention
Crossover technique using a 7Fr long sheath in the opposing femoral artery for contralateral passage and inflation of a balloon in the proximal iliac, followed by Prostar suture closure in a dry field
O
Outcome
Feasibility and safety of the crossover technique for managing vascular access sites and complicationssafety
A crossover balloon inflation technique as an adjunct to Prostar closure is a safe and effective method for managing vascular access sites and complications during transfemoral TAVI.
Abstract
OBJECTIVES: To describe results from a novel percutaneous technique designed to minimize the risk of hemorrhage in the event of a major complication during transcatheter aortic valve implantation. BACKGROUND: Vascular access management is a major challenge in transfemoral TAVI due to the large introducer sheathes required. METHODS: Fifty-two pts underwent TAVI between November 2007 and March 2009. Of these, 37 received an Edwards-Sapien Valve (23 mm valve: 17/37; 26 mm valve: 20/37) whilst 15 patients received a CoreValve (26 mm valve: 6/15; 29 mm valve: 9/15). Using a crossover technique, the opposing femoral artery was cannulated with a 7Fr long sheath. This allowed contralateral passage of a balloon and inflation in the proximal iliac. The sheath was then removed and Prostar sutures tied in a dry field. Balloon optimization of the puncture site was performed as required. RESULTS: In three subjects, elective surgical repair was undertaken due to excessive femoral arterial calcification. In the remaining 49, the crossover technique was employed and closed with two Prostar devices (Edwards-Sapien) or one (CoreValve). There were serious "on-table" complications in seven patients, six due to the large introducer sheathes used in the TAVI procedure-iliac avulsion, two iliac dissections, iliac perforation, common femoral perforation and scrotal hematoma. All were repaired safely by combined surgical and endovascular techniques, using the crossover technique to ensure patient stability. All made a good recovery and were independently ambulant at discharge. CONCLUSION: Using crossover balloon inflation as an adjunct to Prostar closure may be helpful for managing TAVI vascular access sites.