Aorto-iliac angiography as a screening tool in selecting patients for transfemoral aortic valve implantation with the Edwards SAPIEN bioprosthesis

Abstract

Transcatheter aortic valve replacement (TAVR) is a promising therapeutic option for patients with severe aortic stenosis (AS) considered at too high risk for conventional aortic valve replacement. The balloon-expandable Edwards valve can be implanted using either the transfemoral or transapical routes, depending on arterial ilio-femoral suitability. The aim of the study was to evaluate the usefulness of ilio-femoral angiography as an initial screening tool for TAVR using the transfemoral approach with the Edwards SAPIEN valve. Aortography with bilateral ilio-femoral run-off was assessed in the antero-posterior projection. Minimal arterial diameter, vessel tortuosity and calcification were assessed. Transfemoral implantation was appropriate when the minimal arterial diameter was >7 mm for a 23 mm trans-catheter heart valve (THV) and >8 mm for a 26 mm THV with limited calcifications and tortuosity. Included were 135 patients with severe aortic stenosis undergoing cardiac catheterisation before conventional aortic valve replacement or TAVR. Mean femoral artery diameter was 7.5+/-1.3 mm and mean iliac artery diameter was 9.3+/-2.3 mm. There was no or moderate tortuosity in 72% of them. Calcifications were absent or moderate in 83%. At first sight, the transfemoral route was considered potentially suitable in 71% of patients for a 23 mm THV and 39% of patients for a 26 mm TAVI. In the course of haemodynamic and angiographic evaluation of patients with severe symptomatic aortic stenosis, angiography of the ilio-femoral access can be used as a first screening modality to determine potential candidacy for a transfemoral TAVR using a balloon expandable THV.