Vascular Access And Closure Management In Patients With Severe And Morbid Obesity Undergoing Transcatheter Aortic Valve Replacement
Justin Price, Christopher Puleo, Natalia Giraldo, Arthur Davis, Austin Tutor, Jose Tafur Soto, Stephen Ramee
Background Morbid obesity is an ongoing epidemic which presents increasing difficulties for vascular access and closure during transcatheter aortic valve replacement (TAVR). To reduce vascular complications, operators are electing for alternative TAVR access routes in the obese population who have an increased risk of peripheral arterial disease (PAD). Objective To demonstrate successful management of difficult vascular access TAVR patients in an experienced endovascular treatment center. Methods We performed a retrospective analysis of patients with a body max index >35 Kg/m2 who underwent percutaneous transfemoral TAVR between 2016 and 2019. Demographics and data regarding vascular complications were summarized and displayed as a mean ± SD. All procedures were performed via a percutaneous transfemoral approach and concluded with a percutaneous closure device. Vascular complications were defined based on the Valve Academic Research Consortium-2 consensus document (VARC-2) criteria. All patients underwent extensive pre-procedural planning including CT Angiography or intravascular ultrasound for iliofemoral vessel sizing. Results A total of 159 patients met inclusion criteria, 97 patients (61%) were Class II Obesity (BMI ≥ 35-39 .9), and 62 (39%) were (Class III obesity, BMI ≥ 40). The mean age was 73 years (47 -93). The mean STS score was 3.1% (1-17). There were 1 (0.6%) VARC-2 major and 12 (7.5%) VARC-2 minor complications with 10 (6.3%) patients required covered stenting. The mean length of stay was 1.5 days. A total of 3 patients required in hospital blood transfusions. In- hospital and 30-day mortality were 1.2% and 2.5% respectively. Conclusions Severe and morbidly obese patients can successfully undergo percutaneous transfemoral TAVR with minimal vascular complications. Management of these higher risk patients requires operators with experience in endovascular management.
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