Elsevier

The American Journal of Cardiology

Volume 145, 15 April 2021, Pages 119-127
The American Journal of Cardiology

Standardized Measurement of Femoral Artery Depth by Computed Tomography to Predict Vascular Complications After Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.amjcard.2020.12.089Get rights and content

Vascular complications (VCs) are difficult to predict and remain an important issue after transfemoral (TF) transcatheter aortic valve implantation (TAVI) although their incidence has decreased with size reduction of introducers. We aimed to evaluate a standardized measurement of femoral artery depth (FAD) using computed tomography (CT) to predict VCs after TAVI. We performed a retrospective study of 679 TF TAVI patients. We evaluated a standardized CT method to measure FAD immediately above the bifurcation. Sheath-to-femoral-artery ratio (SFAR), calcification, and tortuosity were also evaluated. VCs were defined by the Valve Academic Research Consortium (VARC)-2. Receiver operating characteristic (ROC) curves were used to predict major VCs and the need for a stent-graft. The median values of FAD and SFAR were 49.0 (36.2 to 66.7) mm and 0.95 (0.81 to 1.18), respectively. Major VCs occurred in 37 (5.4%) patients and a stent-graft was required in 49 (7.1%) patients. FAD predicted the need for a stent-graft [0.61 (0.51 to 0.70), p = 0.04] but not major VCs [0.52 (0.40 to 0.63), p = 0.76]. In contrast, SFAR did not predict the need for a stent-graft [0.53 (0.43 to 0.62), p = 0.61] but predicted major VCs [0.70 (0.58 to 0.81), p = 0.001]. Calcification and tortuosity predicted neither major VCs nor the need for a stent-graft. In conclusion, the results of our study suggest that CT measurements of FAD and SFAR provide additional information to predict major VCs and the need for a femoral stent-graft after TF TAVI.

Section snippets

METHODS

Between January 2013 and December 2018, 1,411 consecutive patients were prospectively included in our TAVI database. All patients selected by our multidisciplinary team had severe symptomatic aortic stenosis and gave written informed consent. Patients who had TAVI via a nonfemoral route and who did not have CT in our center or when CT was not archived were excluded. The study was approved by our local ethics committee with a waiver for retrospective analysis.

Pre-procedural MDCT examinations

RESULTS

The flowchart of the studied population is presented in Figure 2. From January 2013 to December 2018, 1,411 patients had TAVI in our center. Among them, 182 (12.9%) patients were excluded because they were implanted via a nonfemoral route. An additional 540 (38.3%) TF TAVI patients were excluded because MDCT was performed in another center or was not archived in the picture archiving computerized system (PACS) currently used in our center (Carestream, Rochester, New York). Thus, 689 (55.7%) TF

DISCUSSION

We aimed to evaluate a new MDCT parameter (i.e., measurement of FAD), in addition to usual parameters, to predict major VCs and the need for a stent-graft after TF TAVI. The main results can be summarized as follows: (1) FAD measurement using standardized MDCT is easy and reproducible and was significantly increased in patients requiring a stent-graft; (2) FAD was the only predictor of the need for a stent-graft although ROC curve analysis indicated poor accuracy with a threshold value of

CREDIT AUTHOR STATEMENT

Eric Durand, Jean Nicolas Dacher and Helene Eltchaninoff have contributed to conception and design, acquisition of data, analysis and interpretation of data, drafting and revisiting the manuscript; Eric Durand has performed statistical analysis; Marylin penso, Stephanie Wong Thibault Hemery, Thomas Levesque, Gustavo Moles, Christophe Tron, Najime Bouhzam, Nicolas Bettinger have contributed to acquisition and interpretation of data.

DECLARATION OF COMPETING INTEREST

Eric Durand has received lecture fees from Edwards Lifesciences.

ACKNOWLEDGMENT

The authors are grateful to Nikki Sabourin-Gibbs for her help in editing the manuscript. Professors Eric Durand and Hélne Eltchaninoff have received a grant by the French Government, managed by the National Research Agency (ANR) under the program “Investissements d'avenir” with the reference ANR-16-RHU-0003.

REFERENCES (24)

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