P197 - SINGLE ARTERIAL ACCESS FOR TRANSFEMORAL TRANSCATHETER AORTIC VALVE IMPLANTATION WITH THE ACURATE NEO SELF-EXPANDING AORTIC BIOPROSTHESIS: INSIGHTS FROM THE LONDON HEALTH SCIENCES CENTRE HEART TEAM

Thursday, October 27, 2022

5:07 PM – 5:15 PM EDT

Location: Room 210

Presenter(s)

Rodrigo Bagur

Interventional Cardiologist
London Health Sciences Centre
Western University
LONDON, Ontario, Canada

First Author(s)

Rodrigo Bagur

Interventional Cardiologist
London Health Sciences Centre
Western University
LONDON, Ontario, Canada

Senior Author(s)

Rodrigo Bagur

Interventional Cardiologist
London Health Sciences Centre
Western University
LONDON, Ontario, Canada

Supervisor(s)

Rodrigo Bagur

Interventional Cardiologist
London Health Sciences Centre
Western University
LONDON, Ontario, Canada

Author(s)

Rodrigo Bagur

Interventional Cardiologist
London Health Sciences Centre
Western University
LONDON, Ontario, Canada
MC

Michael W. Chu, MD, MEd, FRCSC

Professor and Chief of Cardiac Surgery
Western University
London, Ontario, Canada
PT

Patrick Teefy

Cardiologist
London, Ontario, Canada
JG

Jill Gelinas

London, Ontario, Canada
GC

Gloria Chaumont

London, Ontario, Canada
MV

Matthew Valdis

Surgeon
London Health Sciences Centre
London, Ontario, Canada

Senior Author(s)

PD

Pantelis Diamantouros, MD FRCPC

Cardiologist
London, Ontario, Canada

Background: Refinements in transcatheter aortic valve technologies have led to a reduction in delivery systems profiles and, along with expandable introducer sheaths, reducing the incidence of vascular complications. Nonetheless, a second arterial access is needed to landmark the aortic cusps while obtaining a coplanar view. We aimed to report our single-center experience of using a single-arterial access for transcatheter aortic valve implantation (TAVI) with the Acurate neo (Boston Scientific, Marlborough, USA) self-expanding aortic bioprosthesis.

METHODS AND RESULTS: Technique: TAVI with the Acurate neo system was performed by transfemoral access in a hybrid operating room. Femoral arterial access was obtained using fluoroscopy and ultrasound guided and two suture-mediated Perclose ProGlide (Abbott Laboratories, Chicago, IL, USA) devices were deployed for preclosure technique. A 14-French expandable iSleeve sheath (Boston Scientific, Marlborough, USA) was then inserted. The hemostatic valve of the iSleeve sheath was punctured at 2 o’clock (close to the outer edge, Figure) using an 18G needle, a 0.035” J-type wire advanced, and a 5-French pigtail was inserted over-the-wire. Balloon aortic valvuloplasty was performed in all patients using rapid pacing over the Safari 2 (Boston Scientific, Marlborough, USA) preshaped wire. Afterwards, the delivery system with the Acurate neo was advanced over the Safari 2 wire and TAVI performed as per standard practice.
Analyses: Outcomes were assessed according to valvular academic research consortium (VARC-3) criteria at 30 days.

Results: A total of 100 patients (mean age of 85±6 years, 60% women) were included. Procedures were successfully performed in all patients. There were no conversions to surgery, and 2 (2%) needed surgical repairs of the femoral artery. One (1%) patient had an in-hospital stroke. Length of hospital stay was 1.4±1.6 days. Six (out of 93 [6.5%] without prior pacemaker) required new permanent pacemaker implantation, and there were no deaths at 30 days.

Conclusion: Single access for TAVI with the Acurate neo and iSleeve is safe and effective in avoiding the need for a secondary access, thereby reducing the risks of further vascular non-access site related complications.