| A new technique for vascular access management in transcatheter aortic valve implantation. | |
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MedLine Citation:
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PMID: 20049970 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Andrew S P Sharp; Iassen Michev; Francesco Maisano; Maurizio Taramasso; Cosmo Godino; Azeem Latib; Paulo Denti; Enrica Dorigo; Andrea Giacomini; Giuseppe Iaci; Mario Manca; Alfonso Ielasi; Matteo Montorfano; Ottavio Alfieri; Antonio Colombo |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Volume: 75 ISSN: 1522-726X ISO Abbreviation: Catheter Cardiovasc Interv Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-30 Completed Date: 2010-06-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100884139 Medline TA: Catheter Cardiovasc Interv Country: United States |
Other Details:
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Languages: eng Pagination: 784-93 Citation Subset: IM |
Copyright Information:
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(c) 2009 Wiley-Liss, Inc. |
Affiliation:
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San Raffaele Scientific Institute and Columbus Hospitals, Milan, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Aortic Valve* Balloon Occlusion* / instrumentation Equipment Design Femoral Artery* / radiography Heart Catheterization* / adverse effects, instrumentation Heart Valve Diseases / radiography, therapy* Heart Valve Prosthesis Heart Valve Prosthesis Implantation / adverse effects, instrumentation, methods* Hemorrhage / etiology, prevention & control* Humans Iliac Artery* / radiography Prosthesis Design Punctures Radiography, Interventional Suture Techniques Tomography, X-Ray Computed Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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