1Universitätsklinikum Knappschaftskrankenhaus Bochum Kardiologie, Angiologie und internistische Notfallmedizin Bochum, Deutschland; 2Stiftungklinikum PROSELIS gGmbH Med. Klinik II Recklinghausen, Deutschland; 3Klinikum der Ruhr-Universität Bochum Medizinische Klinik II, Kardiologie Bochum, Deutschland
Background:
Pre-procedural renal dysfunction is associated with worse outcomes including increased mortality in patients undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI). Use of contrast media (CM) is a prerequisite for TF-TAVI without use of periinterventional transesophageal echocardiography (TEE). We evaluated the feasibility of fluoroscopy guided TF-TAVI (FG-TF-TAVI) without CM or TEE in patients with impared renal function.
Methods:
Data of 13 consecutive patients undergoing FG-TF-TAVI with the balloon-expandable bioprosthesis were analyzed. Preinterventional evaluation was based on TEE, contrast (n=5) or noncontrast (n=8) computed tomography (MDCT). Fluoroscopy-guided common femoral artery puncture was performed based on bony structures. The perpendicular plane was assessed by placing the pigtail catheter in all all three aortic cusps. Clinical and echocardiographic outcomes were assessed at 30 days.
Results:
TF-TAVI was performed under conscious sedation (CS) and was successful in all patients without any complications. (Mean age of 79.9±6.1 years, 46% male, EuroSCORE II: 14.0 ± 6.8%, STS [Society of Thoracic Surgeons] score: 7.7 ± 3.7%). The mean procedural time was 51,2 ± 11,2 minutes. All patients with borderline annulus (n=5) size received the smaller prosthesis according to a standartised undersizing but overfilling protocoll. At least moderate paravalvular leackage (PVL) did not occur. Two patients had mild PVL and no patient underwent postinterventional pacemaker implantation. Mortality was 0%.
Conclusion:
FG-TF-TAVI under CS can be successfully performed in patients with severe symptomatic aortic stenosis and impaired renal function without CM or TEE.