Transcatheter aortic valve implantation-related vascular access complications: Are balloon-expandable stent grafts a good option?

BACKGROUND

Among the most challenging complications of transfemoral transcatheter aortic valve implantation (TF-TAVI) are vascular access complications (VACs), with access-site bleeding frequently impacting outcomes despite preclosing techniques. Endovascular bailout strategies have become increasingly common despite historical concerns about stent placement in flexing zones.

AIMS: To evaluate the efficacy and safety of balloon-expandable stent graft (BESG) implantation for VACs in patients undergoing TF-TAVI with a preclosure device.

METHODS

This retrospective single-centre study included all consecutive patients who underwent TF-TAVI between January 2010 and December 2020. BESG implantation was used for persistent femoral bleeding following closure failure. Baseline, procedural and clinical data were compared between BESG recipients and controls in accordance with Valve Academic Research Consortium 3 (VARC-3) criteria.

RESULTS

Among 1248 patients (mean±standard deviation age 83.1±7.3 years; 52.3% female), 225 (18.0%) had persistent femoral bleeding, and 98 (7.8%) required BESG implantation. Compared with controls, patients with BESG had larger sheath sizes (e.g. size 18 Fr: 73.5% vs 47.8%, P<0.001) and higher contrast use (199.2±81.9 vs 150.1±64.0mL, P<0.001). At 1 year, the composite endpoint of all-cause death, vascular reintervention or new-onset claudication occurred in 34.7% of patients with BESG and 29.0% of controls (P=0.24). After propensity matching, outcomes remained comparable (risk ratio 0.98, 95% confidence interval 0.58-1.65; P=0.95).

CONCLUSION

In this retrospective single-centre cohort, BESG implantation appeared to be safe and may be an effective fully percutaneous bailout option for access-site bleeding after TF-TAVI.