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. 2023 Nov 3:10:1228258.
doi: 10.3389/fcvm.2023.1228258. eCollection 2023.

Single femoral artery access is safe and feasible during transcatheter aortic valve replacement: a propensity score matched analysis

Yunfeng Yan #  1 , Jing Yao #  1 , Fei Yuan  1 , Xinmin Liu  1 , Taiyang Luo  1 , Zhinan Lu  1 , Sanshuai Chang  1 , Qian Zhang  1 , Ran Liu  1 , Chengqian Yin  1 , Guangyuan Song  1
Affiliations

Single femoral artery access is safe and feasible during transcatheter aortic valve replacement: a propensity score matched analysis

Yunfeng Yan et al. Front Cardiovasc Med. .

Abstract

Background: Transcatheter aortic valve replacement (TAVR) potentially may be significantly simplified by using the single artery access (SA) technique, which does not require a secondary artery access. Nevertheless, the safety and efficacy of this technique remains unclear. Our goal was to determine if single artery access TAVR (without upgrading the sheath size) is a feasible, minimally invasive procedure.

Methods: Patients with symptomatic severe aortic stenosis who underwent TAVR via the femoral artery were consecutively enrolled in this study. Eligible individuals were divided into 2 groups: the SA group and the dual artery access (DA) group. The primary end point was device success (defined by the valve academic research consortium 3, VARC 3). A 6-month follow-up and propensity score matching analyses were performed.

Results: After propensity score matching analysis, a total of 130 patients were included: 65 in the SA group and 65 in the DA group. The SA procedure achieved similar device success (95.4% vs. 87.7%; P = 0.115) compared with the DA procedure. The SA procedure shortened the operating time (102 min vs. 125 min; P = 0.001) but did not increase the x-ray time or dose. Both a 20 Fr and a 22 Fr sheath (without upgrading the sheath size) could be used for the SA procedure. There was no major vascular complication occurred in both groups. The incidence of minor main vascular and access complications in the SA group was comparable to those of the DA procedure (0.0% vs. 3.1%; P = 0.156).

Conclusions: The SA access procedure is a promising minimally invasive TAVR technique with a low incidence of vascular complications and a high incidence of device success. It is safe and possibly applicable in all TAVR procedures.

Keywords: propensity matched analysis; simplification; single artery access procedure; transcatheter aortic valve replacement; transfemoral.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Diagram of the single artery access technique. I (A,B) A 5 Fr pigtail catheter is inserted into the aortic root for an aortogram with the 5 Fr sheath inside the large sheath; balloon dilation occurs through the same sheath. II (A,B) After the 5 Fr pigtail and the balloon are removed, the transcatheter heart valve (THV) delivery system is inserted into the descending aorta. III (A,B) The pigtail catheter is inserted from the single femoral access up to the bottom of the aortic root; then the THV is delivered to the aortic root. (a) A 5F sheath with pigtail catheter; (b) large sheath; (c) balloon; (d) THV delivery system.
Figure 2
Figure 2
Flow chart. AS, aortic stenosis; DA, dual artery access; SA, single artery access; THV, transcatheter heart valve.
Figure 3
Figure 3
Absolute standard difference before and after propensity score matching.
See this image and copyright information in PMC

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