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Feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters

Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Objectives

We intended to show feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters.

Background

Transcatheter aortic valve implantation (TAVI) has emerged as a valid treatment option in patients with aortic valve stenosis who are poor candidates for surgical aortic valve replacement. Few patients, who cannot undergo transfemoral or transsubclavian aortic valve implantation due to small access vessel diameters, are not suitable for transapical or direct aortic valve implantation, either.

Methods

In more than 700 transcatheter aortic valve implantations since 2008 we identified 17 patients who had to be excluded from transfemoral valve implantation due to vessel diameters <6 mm and who were no candidates for transapical or direct aortic implantation. We performed CoreValve™ implantations in these patients without the required 18F sheath to cross the vessels despite their small size (4.6–5.9 mm).

Results

Sixteen sheathless implantations were successful. In all 17 patients, bleeding during the procedure due to the smaller delivery catheter was minimal. Sixteen patients had a successful access site closure at the end of the procedure.

Conclusions

Sheathless implantation of a self-expanding aortic valve can be safely considered in selected patients with access vessel diameters below 6 mm, if transapical or direct aortic implantation is not suitable.

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Abbreviations

AV-Block:

Atrioventricular block

F:

French

STS:

Society of thoracic surgeons

TAVI:

Transcatheter aortic valve implantation

VARC:

Valve academic research consortium

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Conflict of interest

Raffi Bekeredjian and Emmanuel Chorianopoulos are investigators in the ADVANCE II trial. All other authors declare that they have no conflict of interest.

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Geis, N.A., Chorianopoulos, E., Kallenbach, K. et al. Feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters. Clin Res Cardiol 103, 775–780 (2014). https://doi.org/10.1007/s00392-014-0713-3

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  • DOI: https://doi.org/10.1007/s00392-014-0713-3

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