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Feasibility and safety of transfemoral sheathless portico aortic valve implantation: Preliminary results in a single center experience

Maurizio Taramasso, Andrea Denegri, Shingo Kuwata, Hans Rickli, Philipp K. Haager, Gabor Sütsch, Hector Rodriguez Cetina Biefer, Jan Kottwitz, Fabian Nietlispach & Francesco Maisano

abstract

BACKGROUND
Feasibility of transfemoral (TF) transcathteter aortic valve replacement (TAVR) is limited by the smallest diameter, the calcification and tortuosity of the iliofemoral access vessels. The use of the Portico system without delivery sheath results in significantly lower profile delivery system compared to standard technique. We herein report our single center experience, feasibility and safety of such an approach.

METHODS
The Portico valve was implanted sheathless in 81 high-risk patients with severe aortic stenosis utilizing percutaneous femoral access. Mean minimal diameter of the ileo-femoral arterial access was 7.06 ± 1.89 mm. In most cases a multidetector computed tomography was performed before the intervention to assess the feasibility of vascular access and for aortic annulus measurements. The vascular access site was preclosed using two ProGlide suture systems.

RESULTS
Device implantation was successful 98.7% of patients. Valve recapturing and repositioning as well as valve-in-valve deployment was performed in only one case (1.2%). There were no infarctions, 2 strokes (2.4%) and 2 acute kidney failure (2.4%), 1 major vascular complication1 (1.2%) 4 major bleedings (4.9%), 11 conductions disturbances and relative pace-maker implantations (14.2%). The mean gradient decreased from 42.3 ± 17 to 6.3 ± 2.78 mm Hg. Paravalvular regurgitation as assessed by TTE at discharge was absent or trivial in 19 patients, mild in 60 and moderate 1. Thirty-day mortality was 2.4%.

CONCLUSIONS
Sheathless use of the Portico valve is feasible and appears to be safe, with excellent rates of complications and mortality in the short-term. Such an approach has the potential to further expand feasibility of TF TAVR to patients with severe peripheral arterial disease. Feasibility in patients with smaller femoral access and more challenging anatomy has to be proven in further studies. © 2017 Wiley Periodicals, Inc.
   
citation Taramasso M, Denegri A, Kuwata S, Rickli H, Haager P K, Sütsch G, Rodriguez Cetina Biefer H, Kottwitz J, Nietlispach F, Maisano F. Feasibility and safety of transfemoral sheathless portico aortic valve implantation: Preliminary results in a single center experience. Catheter Cardiovasc Interv 2017; 91:533-539.
   
type journal paper/review (English)
date of publishing 13-05-2017
journal title Catheter Cardiovasc Interv (91/3)
ISSN electronic 1522-726X
pages 533-539
PubMed 28500739
DOI 10.1002/ccd.27100