Abstract 18372: Peripheral Intravascular Lithotripsy to Facilitate Transfemoral Transcatheter Aortic Valve Replacement - Updated Outcomes

Abstract

Background: Transfemoral transcatheter aortic valve replacement (TF-TAVR) approach has proven to be superior to alternative access[1]. However, a subset of patients being evaluated for TF-TAVR are deemed unfit secondary to peripheral arterial disease. Despite reduction of delivery system profiles to 14 - 18 Fr, current systems still pose an increased risk of access vessel injury. For patients anatomically unfit for standard transfemoral access, peripheral intravascular lithotripsy (IVL) has emerged to facilitate femoral access for TAVR. Methods: Single center, retrospective analysis of an institutional patient database, queried from 1/2018 through 12/2022 for all patients undergoing TAVR. All patients undergoing IVL facilitated lithotripsy for transfemoral access were analyzed. Results: A total 2,209 TAVR cases were identified, with 75 (3.78%) having undergone lithotripsy: 14 in 2018, 15 in 2019, 16 in 2020, 13 in 2021, and 17 in 2022. The lithotripsy cohort consisted of 45% female with mean age of 78±9.8 years. Average length of stay was 3 days. Common and external iliac lesions were the most common target (n=41/75), followed by common iliac alone (n=25/75). Majority of IVL was performed with 7-mm lithotripsy catheter (n=55/75). Procedural success was 98.7% (n=74/75). Average fluoroscopy time 31 minutes, and average total contrast infusion 87cc. Average number of pulses per lesion was 260 ±52. Mean target lesion diameter on the right 5.0 ±1.2mm and left 5.3 ±1.3mm. Average aortic valve calcium score was 2405.6 ±1260.4. Total complication rate was 28%. Complications requiring secondary vascular procedure occurred in 5.3% (n=4/75) with femoral stenosis requiring balloon dilation, external iliac pseudoaneurysm and retroperitoneal bleed secondary to common femoral pseudoaneurysm primarily repaired, and CFA occlusion required open endarterectomy. Mortality at 30-days 1.3% (n=1/75). Conclusions: This abstract aims to provide an updated report of a single institution experience for the use of IVL to facilitate transfemoral TAVR. The IVL facilitated TF-TAVR is feasible, safe, and effective at preserving the transfemoral TAVR route in patients with severe peripheral artery disease. [1] Holmes. et al. J Am Coll Cardiol, 2015. 66(25): p. 2813-2823