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Risk Factors for Closure Failure following Percutaneous Transfemoral Transcatheter Aortic Valve Implantation

 Cheol Ho Lee  ;  Young-Guk Ko  ;  Yeonjeong Park  ;  Chi Young Shim  ;  Geu-Ru Hong  ;  Seung Hyun Lee  ;  Sak Lee  ;  Hae Won Jung  ;  Sung-Jin Hong  ;  Chul-Min Ahn  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Donghoon Choi  ;  Myeong-Ki Hong  ;  Yangsoo Jang 
 ANNALS OF VASCULAR SURGERY, Vol.66 : 406-414, 2020-07 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Arterial Occlusive Diseases / etiology ; Catheterization, Peripheral / adverse effects* ; Catheterization, Peripheral / mortality ; Equipment Failure ; Female ; Femoral Artery* / diagnostic imaging ; Femoral Artery* / injuries ; Hemorrhage / etiology ; Hemorrhage / prevention & control* ; Hemostatic Techniques / adverse effects* ; Hemostatic Techniques / instrumentation* ; Hemostatic Techniques / mortality ; Humans ; Male ; Punctures ; Retrospective Studies ; Risk Factors ; Time Factors ; Transcatheter Aortic Valve Replacement / adverse effects* ; Transcatheter Aortic Valve Replacement / mortality ; Treatment Outcome ; Vascular Closure Devices* ; Vascular System Injuries / etiology
Background: The percutaneous access site of transfemoral transcatheter aortic valve implantation (TAVI) procedures is commonly closed using a preclosure technique with suture-type closure devices. We sought to evaluate the predictors and outcomes of percutaneous closure device (PCD) failure during transfemoral TAVI. Methods and results: This single-center retrospective analysis included 184 patients who underwent transfemoral TAVI using 2 ProGlide sutures for severe aortic stenosis between July 2011 and September 2018. PCD failure was observed in 11.4%. The causes of PCD failure included 5 cases of insufficient hemostasis, 13 cases of arterial stenosis or occlusion, and 3 cases of dissection. Closure failures were managed by surgical repair in 10 patients and endovascular treatment in 11 patients. In a multivariate binary logistic model, a minimum lumen diameter of the common femoral artery (CFA) (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.15-0.83, P = 0.017) and left femoral access (OR 2.89, 95% CI 1.01-8.30, P = 0.048) was identified as a predictor of PCD failure. PCD failure was not associated with increased mortality (0% vs. 2.5%, P = 1.000) or a major adverse cardiovascular event (MACE; 4.8% vs. 4.3%, P = 1.000) at 30 days. Conclusions: PCD failures were not uncommon in patients undergoing percutaneous transfemoral TAVI. Small CFA diameter and left femoral access are predictors of PCD failure. However, PCD failures were not associated with increased mortality or MACE.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Ahn, Chul-Min(안철민) ORCID logo https://orcid.org/0000-0002-7071-4370
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
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