Impact of routine crossover balloon occlusion technique on access‐related vascular complications following transfemoral transcatheter aortic valve replacement. Issue 2 (23rd April 2016)

• Record Type: Journal Article
• Authors: Zaman, Sarah; Gooley, Robert; Cheng, Victoria; McCormick, Liam; Meredith, Ian T.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 88:Issue 2(2016)
• Page Start: 276
• Page End: 284
• Publication Date: 2016-04-23
• Subjects: vascular complications -- aortic valve disease -- percutaneous intervention -- vascular closure -- peripheral intervention; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.26371
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract : Objectives: To determine the impact of incorporating routine crossover balloon occlusion technique (CBOT) for vascular access closure following transcatheter aortic valve replacement (TAVR) on major access‐site‐related complications. Background: Vascular complications are associated with increased mortality following TAVR. The CBOT involves passage of a balloon catheter from the contralateral femoral artery to enable controlled closure of large‐sheath access‐sites. Methods: Consecutive patients who underwent transfemoral TAVR as part of three clinical trials were prospectively recruited. Patients who had routine CBOT (CBOT group, n = 55) were compared to preceding patients who did not undergo CBOT (control group, n = 43). The primary endpoint was 30‐day occurrence of access‐site‐related Valve Academic Research Consortium (VARC)−2 defined major vascular and/or bleeding complications. Results: CBOT was successfully performed in 96% with 2% occurrence of a minor CBOT‐related complication. At 30‐days access‐site‐related major vascular and/or bleeding occurred in 5.5% and 18.6% of the CBOT and control group, respectively ( P = 0.042). This consisted of VARC‐2 major vascular events in 3.6% and 16.3% ( P = 0.036) and VARC‐2 major/life‐threatening bleeding events in 5.5% and 14.0% ( P = 0.137) of the CBOT and control group, respectively. Transfusion of ≥2 units of packed red blood cells were required in 10.9% and 30.2% of the CBOT and control group, respectively ( P = 0.016). There was no significant difference in contrast load, procedure time, and kidney injury between the two groups. Conclusions: Routine CBOT for TAVR access‐site closure has a high success rate and is associated with a significant reduction in VARC‐2 major vascular and bleeding complications compared to TAVR performed without CBOT. © 2016 Wiley Periodicals, Inc.