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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2016 August;57(4):615-9
The routine use of surgical exposure approach for trans-femoral implantation of the balloon expandable aortic prosthesis is associated to a low rate of vascular complications
José M. DE LA TORRE HERNÁNDEZ 1, Raul MORENO 2, Dae H. LEE 1, Bruno GARCIA DEL BLANCO 3, Juan C. SANMARTIN 4, Sergio GARCIA BLAS 2, Vicenç SERRA GARCIA 3, Koldo GAVIRIA 4, Ivan GARCIA 1, Javier ZUECO 1 ✉
1 Cardiovascular Department, Marques de Valdecilla University Hospital, Santander, Spain; 2 Cardiovascular Department, Hospital Vall d'Hebron, Barcelona, Spain; 3 Cardiovascular Department, Hospital La Paz, Madrid, Spain; 4 Cardiovascular Department, Policlinica Guipuzcoa y Hospital Arantzazu Donostia, San Sebastian, Spain
BACKGROUND: The most frequent complications of transfemoral aortic valve implantation are vascular (15-25%) and are related to an increase in mortality. We sought to assess the rate of vascular complications, its treatment and outcomes using a surgical approach for transfemoral implantation of Edwards-SAPIEN (Edwards Lifescience, Irvine, CA, USA) aortic valve.
METHODS: We have conducted a multicenter registry including 4 hospitals using a systematic surgical exposure approach. Vascular complications have been collected following the definitions of the Valve Academic Research Consortium.
RESULTS: From 2008 to 2013 a total of 312 consecutive patients have been included. Vascular complications were reported in 22 (7%), among those 6 (1.9%) were major whereas 16 (5.1%) were minor. Patients suffering vascular complications had significantly more previous history of peripheral vascular disease. All but one major complications occurred in women, aged 82-88 and with chronic renal failure. Hospital stay was longer in cases suffering complications (17.8±11 days vs. 9±7 days; P<0.0001). The 30 days mortality was 13.6% in patients with vascular complications, 33.3% in patients with major complications and 5.5% in patients with no complications (P=0.05).
CONCLUSIONS: In this registry, the systematic use of a surgical exposure of the femoral artery for TAVR has been associated with a lower rate of vascular complications.