Risk Factors for Closure Failure following Percutaneous Transfemoral Transcatheter Aortic Valve Implantation

Cheol Ho Lee, Young Guk Ko, Yeonjeong Park, Chi Young Shim, Geu Ru Hong, Seung Hyun Lee, Sak Lee, Hae Won Jung, Sung Jin Hong, Chul Min Ahn, Jung Sun Kim, Byeong Keuk Kim, Donghoon Choi, Myeong Ki Hong, Yangsoo Jang

Research output: Contribution to journalArticle

Abstract

Background: The percutaneous access site of transfemoral transcatheter aortic valve implantation (TAVI) procedures is commonly closed using a preclosure technique with suture-type closure devices. We sought to evaluate the predictors and outcomes of percutaneous closure device (PCD) failure during transfemoral TAVI. Methods and Results: This single-center retrospective analysis included 184 patients who underwent transfemoral TAVI using 2 ProGlide sutures for severe aortic stenosis between July 2011 and September 2018. PCD failure was observed in 11.4%. The causes of PCD failure included 5 cases of insufficient hemostasis, 13 cases of arterial stenosis or occlusion, and 3 cases of dissection. Closure failures were managed by surgical repair in 10 patients and endovascular treatment in 11 patients. In a multivariate binary logistic model, a minimum lumen diameter of the common femoral artery (CFA) (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.15–0.83, P = 0.017) and left femoral access (OR 2.89, 95% CI 1.01–8.30, P = 0.048) was identified as a predictor of PCD failure. PCD failure was not associated with increased mortality (0% vs. 2.5%, P = 1.000) or a major adverse cardiovascular event (MACE; 4.8% vs. 4.3%, P = 1.000) at 30 days. Conclusions: PCD failures were not uncommon in patients undergoing percutaneous transfemoral TAVI. Small CFA diameter and left femoral access are predictors of PCD failure. However, PCD failures were not associated with increased mortality or MACE.

Original languageEnglish
JournalAnnals of Vascular Surgery
DOIs
Publication statusAccepted/In press - 2020 Jan 1

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

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    Lee, C. H., Ko, Y. G., Park, Y., Shim, C. Y., Hong, G. R., Lee, S. H., Lee, S., Jung, H. W., Hong, S. J., Ahn, C. M., Kim, J. S., Kim, B. K., Choi, D., Hong, M. K., & Jang, Y. (Accepted/In press). Risk Factors for Closure Failure following Percutaneous Transfemoral Transcatheter Aortic Valve Implantation. Annals of Vascular Surgery. https://doi.org/10.1016/j.avsg.2019.12.034