The safety and efficacy of temporary distal aortic occlusion to facilitate TAVR large-bore arterial closure.

OBJECTIVES

To evaluate the safety and efficacy of temporary distal aortic occlusion (TDAO) for facilitated large-bore arterial closure during transcatheter aortic valve replacement (TAVR).

BACKGROUND

Ipsilateral iliac artery occlusion and TDAO have been used to facilitate TAVR delivery sheath access-site closure, but ipsilateral iliac artery occlusion has been associated with arterial complications at the balloon site.

METHODS

TDAO was performed in 117 consecutive transfemoral TAVR cases from July 2010 to April 2012. The valve delivery access site was preclosed with suture-mediated closure devices (n = 100) or had a planned surgical cutdown performed (n = 17). TDAO was performed using a 22 mm x 5 cm Tyshak II balloon, which was deployed at the minimum pressure to stop antegrade blood flow in the distal abdominal aorta via a contralateral 8 Fr femoral sheath. This served to occlude iliac run-off as the TAVR delivery sheath access site was closed. Final aortogram with bilateral run-off was performed to evaluate for aortic, iliac, or femoral dissection or rupture, or ilio-femoral vascular complications in accordance with Valve Academic Research Consortium (VARC)-2 criteria.

RESULTS

TDAO was successfully performed in all patients with no complications related to the TDAO technique itself. There were vascular complications related to the TAVR procedure. 7 patients (6.0%) had VARC-2 major vascular complications and 16 patients (13.7%) had VARC-2 minor vascular complications.

CONCLUSIONS

TDAO is a safe and effective technique to facilitate large-bore arterial closure by both percutaneous and open surgical closure techniques.