Incidence of Pseudoaneurysm Formation after Transcatheter Aortic Valve Replacement: A single center experience

Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Teah Qvavadze, MD , Monmouth Medical Center, Newark, NJ
Alexis Okoh , Newark Beth Israel Med Ctr Card, newark, NJ
Swaiman Singh, MD , Newark Beth Israel Med Ctr Card, Newark, NJ
Nawar Al Obaidi , Newark Beth Israel Med Ctr Card, newark, NJ
Adarshjit Singh, MD , Newark Beth Israel Med Ctr Card, newark, NJ
Setri Fugar, M.D. , Rush University Medical Center, Chicago, IL
Bruce J Haik, M.D. , Saint Barnabas Medical Center, West Orange, NJ
Chunguang Chen, MD , Newark Beth Israel Medical Center, Chicago, IL
Marc Cohen, M.D. , Newark Beth Israel Hospital, Newark, NJ
Cindy Sturt, MD , Newark Beth Israel Medical Center, Newark, NJ
Bruce Brener, MD , Newark Beth Israel Medical Center, Newark, NJ
Mark J. Russo, M.D. , RWJBarnabas Health, Newark, NJ

Background:
The purpose of this study was to describe the incidence, management and potential predictors of PSA at a high-volume TAVR center.

Methods:
This is a retrospective analysis of a prospectively maintained TAVR database that included percutaneous transfemoral (TF)TAVR patients between November 2013 and October 2018. Patients with extended groin pain or newly developed groin swelling after TAVR were examined by ultrasound (US). The incidence of PSA formation was recorded. Size of aneurysms, anatomic location with respect to TF-TAVR access vs diagnostics sites, and respective management were documented. The impact of PSA formation on post-operative length of stay (PLOS) and readmission within 30-days post-procedure was investigated. Logistic regression models were used to identify predictors of PSA.

Results:
Over the study period, a total of 871 patients with a mean ± SD age of 82 ± 8 years had percutaneous TF-TAVR. The incidence of PSA was 1.4 % (n=12). Size of PSA was > 2cm in 9 (75 %) and < 2 cm in 3 (25 %) patients. Vessels involved were the CFA (n=9), EIA (n=1) and SFA (n=2). A PSA occurred in a vessel on diagnostic access site in 9 (75%) patients. Of the 12 patients, 11 received treatment with thrombin injection with a 92% success rate (surgical exploration after failed thrombin treatment (n=1)), while 1 patient required direct surgical exploration. Mean PLOS was significantly higher for PSA patients than those who did not develop a PSA (7±7 vs. 3±4 days, p=0.0012). Readmission within 30-days was similar between both groups (8% vs. 19%, p=0.317). On multivariable logistic regression analysis, factors associated with the formation of PSA were frailty (p=0.014), history of coronary artery disease (p=0.026) and baseline ≥ moderate aortic valve regurgitation (p=0.034). Procedure year was protective against PSA formation (p=0.017).

Conclusions:
The incidence of PSA formation after TAVR is encouragingly low at an experienced center. PSA is mostly encountered on the diagnostic side, indicating that hypercoagulable state and manual compression may not be enough for adequate seal. Albeit its low incidence, formation of PSA is associated with increased resource utilization after TAVR.

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