Ipsilateral vs Contralateral Angiography Sheath Placement For Transcatheter Aortic Valve Replacement: A 4 Year Analysis of Vascular Complications

Bazarbashi, Najdat

Ipsilateral vs Contralateral Angiography Sheath Placement For Transcatheter Aortic Valve Replacement: A 4 Year Analysis of Vascular Complications

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Najdat Bazarbashi, M.D. , Cleveland Clinic, Cleveland, OH

Shameer Khubber, MD , Cleveland Clinic, Cleveland, OH

Divyanshu Mohananey, MD , Cleveland Clinic, Cleveland, OH

Amer Kadri, MD , Cleveland Clinic, Cleveland, OH

Manpreet Kaur, MD , Cleveland Clinic, Cleveland, OH

Yasser M Sammour, MD , Cleveland Clinic Foundation

Mohamed M Gad, MD , Cleveland Clinic, Cleveland, OH

Megan Lyden , Cleveland Clinic, Cleveland, OH

Keerat R Ahuja, MD , Cleveland Clinic, Cleveland, OH

Beni Verma, MD , Cleveland Clinic, Cleveland, OH

Vivek Menon, MD , Cleveland Clinic, Cleveland, OH

Stephanie L Mick, MD , Cleveland Clinic Foundation, Cleveland, OH

Grant W Reed, MD , Cleveland Clinic, Cleveland, OH

Jose L Navia, MD , Cleveland Clinic, Cleveland, OH

Amar Krishnaswamy, M.D. , Cleveland Clinic, Cleveland, OH

Samir Ramesh Kapadia, M.D., FSCAI , Cleveland Clinic, Cleveland, OH

Background
Vascular complications remain an important part of endovascular procedures including Transcatheter Aortic Valve Replacement (TAVR). A second sheath (in addition to the delivery sheath) is usually placed in order to perform aortic root angiography as well as completion angiography to assess delivery sheath vascular closure. In this study, we compared the rate of vascular complications when placing the 2nd sheath either ipsilaterally (distal to the delivery site) or contralaterally.

Methods
Data for patients undergoing Transfemoral Aortic Valve Replacement (TF-TAVR) from January 2014 to December 2017 at the Cleveland Clinic Foundation were queried and analyzed in a retrospective manner. Vascular complications were defined according to the VARC2 criteria, Echocardiographic reports, procedural reports, and baseline characteristics were analyzed. The primary endpoint of this study was the access-related vascular complication.

Results
Of 1262 patients who underwent TAVR, 52 patients (4%) were excluded due to non-femoral approach. Under the TF-TAVR, 1208 patients (95.72%) were included in this study. 1007 patients (83.3%) underwent a contralateral femoral access point, and 201 patients (16%) went through TF-TAVR via a single femoral approach. Furthermore, the single access approach was utilized in 43.7 % of patients from January 2017 to December 2017, and 56.3% underwent double access TF-TAVR during the same time-frame. Outcomes for propensity-matched groups of vascular-related major and minor complications in the contralateral access group were similar compared to the ipsilateral access group (10.8 % vs 8.6%) (p=0.543). Results of the study also demonstrated a gradual decline in the general number of access site-related vascular complications from 2014 to 2017.

Conclusions
Vascular complications decreased overall during the study period. Further, in addition to the expected decreases with smaller sheath size, unilateral access TF-TAVR provided similar safety to bilateral access. Unilateral access may increase patient satisfaction, and it may provide an easy approach for dealing with complications of access site for balloon angioplasty or stent placement.