Predicting vascular complications during transfemoral transcatheter aortic valve replacement using computed tomography: a novel area-based index

Catheter Cardiovasc Interv. 2014 Nov 1;84(5):844-51. doi: 10.1002/ccd.25488. Epub 2014 Apr 15.

Abstract

Background: Computed tomography (CT) imaging has not been systematically studied for predicting vascular complications during transcatheter aortic valve replacement (TAVR).

Methods: Clinical data were obtained from the electronic medical record and analysis was performed for each individual patient's iliofemoral CT angiogram. Sheath : femoral artery diameter ratio (SFAR) and sheath : femoral artery area ratio (SFAAR) were defined as the ratio of the sheath outer diameter to the femoral minimal lumen diameter (MLD) and sheath area to the femoral minimal lumen area (MLA), respectively.

Results: A total of 255 patients underwent TF-TAVR with a 30-day mortality of 0.4% and 30-day stroke rate of 1.6%. Twenty-eight (11%) patients suffered a vascular complication, the majority of whom (82%) were managed percutaneously. Receiver operating characteristic (ROC) curve analysis demonstrated an SFAAR of 1.35 to predict the occurrence of vascular complications with a sensitivity of 78.6%. By comparison, similar analysis using SFAR provided a value of 1.45 with sensitivity of 64.2%. Multivariable modeling confirmed SFAR [OR (95% CI): 8.3(1.8-39.1)] and log-transformed SFAAR [OR (95% CI): 40.1 (2.4-650.0)] as significant predictors of vascular complication.

Conclusions: Using CT analysis, an SFAR of 1.45 and an SFAAR of 1.35 are each significant predictors of vascular complications among patients undergoing TF-TAVR. Utilization of CT-based area may provide a more accurate screen for patients undergoing evaluation for TF-TAVR as it takes into consideration the elliptical nature of the vessel. © 2014 Wiley Periodicals, Inc.

Keywords: aortic valve disease; complications; elderly patients; percutaneous intervention; transcatheter valve implantation; vascular access.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiography / methods
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / surgery*
  • Chi-Square Distribution
  • Cohort Studies
  • Echocardiography, Doppler / methods
  • Female
  • Femoral Artery / diagnostic imaging*
  • Femoral Artery / physiopathology
  • Follow-Up Studies
  • Humans
  • Intraoperative Complications / diagnostic imaging*
  • Intraoperative Complications / mortality*
  • Intraoperative Complications / physiopathology
  • Logistic Models
  • Male
  • Predictive Value of Tests
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Survival Rate
  • Tomography, X-Ray Computed / methods*
  • Transcatheter Aortic Valve Replacement / adverse effects
  • Transcatheter Aortic Valve Replacement / methods*
  • Transcatheter Aortic Valve Replacement / mortality
  • Treatment Outcome