Use of an ePTFE-covered nitinol self-expanding stent graft for the treatment off pre-closure device failure during transcatheter aortic valve replacement

摘要

Objectives: Our aim was to describe our experience with the use of an ePTFE-covered nitinol self-expanding stent graft (GORE? VIABAHN? Endoprosthesis, Gore Medical, USA) placed in the common femoral artery for the treatment of suture-mediated pre-closure device failure following transcatheter aortic valve replacement (TAVR). Background: Access site-related vascular complications (VC) following sheath removal related to pre-closure device failure during TAVR are common and treatment options may vary. Methods: We performed an observational study on a series of consecutive patients who underwent TAVR between 2013 and 2015. Results: Included were 25 patients at a mean (±SD) age of 82 ± 9. Failure of the closure device resulted in overt bleeding in 19 patients, dissection or no flow in 5 patients, and angiographic pseudoaneurysm in 1. Overall 29 stents were deployed with diameters ranging from 8 to 11 mm and a length of 50 mm (26, 90%). All stent-graft deployments achieved complete hemostasis of the arteriotomy site and resulted in normal flow to the distal vessels. None of the patients required open surgical repair. The mean hemoglobin drop was 2.6 ±1.3 g/dl. Blood transfusions were used in 15 (60%) patients. Acute kidney injury occurred in 4(16%) patients, none of whom was treated with dialysis. Length of hospital stay was 9 ± 5 days. All patients survived during a 30-day follow-up period, and none had VC related to the stented site.