Predicting vascular complications during transfemoral transcatheter aortic valve replacement using computed tomography: A novel area‐based index. Issue 5 (15th April 2014)

• Record Type: Journal Article
• Authors: Krishnaswamy, Amar; Parashar, Akhil; Agarwal, Shikhar; Modi, Dhruv K.; Poddar, Kanhaiya L.; Svensson, Lars G.; Roselli, Eric E.; Schoenhagen, Paul; Tuzcu, E. Murat; Kapadia, Samir R.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 84:Issue 5(2014:Nov. 01)
• Page Start: 844
• Page End: 851
• Publication Date: 2014-04-15
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25488
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25488-sec-0001" sec-type="section"> <title>Background</title> <p>Computed tomography (CT) imaging has not been systematically studied for predicting vascular complications during transcatheter aortic valve replacement (TAVR).</p> </sec> <sec id="ccd25488-sec-0002" sec-type="section"> <title>Methods</title> <p>Clinical data were obtained from the electronic medical record and analysis was performed for each individual patient's iliofemoral CT angiogram. Sheath : femoral artery <italic>diameter</italic> ratio (SFAR) and sheath : femoral artery <italic>area</italic> ratio (SFAAR) were defined as the ratio of the sheath outer diameter to the femoral minimal lumen diameter (MLD) and sheath area to the femoral minimal lumen area (MLA), respectively.</p> </sec> <sec id="ccd25488-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 255 patients underwent TF‐TAVR with a 30‐day mortality of 0.4% and 30‐day stroke rate of 1.6%. Twenty‐eight (11%) patients suffered a vascular complication, the majority of whom (82%) were managed percutaneously. Receiver operating characteristic (ROC) curve analysis demonstrated an SFAAR of 1.35 to predict the occurrence of vascular complications with a sensitivity of 78.6%. By comparison, similar analysis using SFAR provided a value of 1.45 with sensitivity of 64.2%. Multivariable modeling confirmed SFAR [OR (95% CI): 8.3(1.8–39.1)] and log‐transformed SFAAR [OR (95% CI): 40.1 (2.4–650.0)] as significant predictors of vascular complication.</p> </sec> <sec id="ccd25488-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Using CT analysis, an SFAR of 1.45 and an SFAAR of 1.35 are each significant predictors of vascular complications among patients undergoing TF‐TAVR. Utilization of CT‐based area may provide a more accurate screen for patients undergoing evaluation for TF‐TAVR as it takes into consideration the elliptical nature of the vessel. © 2014 Wiley Periodicals, Inc.</p> </sec> </abstract>