Reducing access complications in an interdisciplinary structural heart program.

Background: Vascular (VC) and cardiac structural complications (CSC) are frequent complications following transcatheter aortic valve implantation (TAVI). Aim of this single-center retrospective study was to evaluate strategies for minimizing periprocedural access complications as part of an interdisciplinary structural heart program.

Methods: Included were all patients who underwent TAVI between 09/2022 and 08/2023 at our institution. All procedures were performed by a heart team, consisting of a cardiovascular surgeon with peripheral vascular and interventional experience and an interventional cardiologist on site. Valvular type and size, access route and backup strategies were assessed by the heart team according to the preoperative CT-imaging. Baseline characteristics, periprocedural data, complications and 30-day outcomes were analyzed concerning the access route using Mann-Whitney-U-test or Fisher´s exact test.

Results: Analyzed were 167 consecutive patients (81 (76-85) years; 53.3% male). 48 (28.7%) of these had severe peripheral artery disease. 130 (77.8%) procedures were performed via a percutaneous transfemoral approach, 13 (7.8%) via a femoral cut-down and 4 (2.4%) via a transaxillary access. For 20 procedures (11.9%) a transapical access was used. 106 patients (72%) with transvascular and all patients with transapical access received a balloon-expanding valve, whereas 41 (28%) patients with transvascular access received a self-expanding prosthesis. No coronary occlusion was seen. Annular rupture occurred in one patient (0.6%), valve displacement in two patients (1.2%). Totally 5 (3%) access femoral arteries were stented and 8 (4.8%) needed a surgical reconstruction. 30-day mortality was 2.99%.

Conclusions: On site interventional and cardiovascular surgical expertise may minimize VC and CSC following TAVI.