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Predicting vascular complications during transfemoral transcatheter aortic valve replacement using computed tomography: A novel area‐based index
Author(s) -
Krishnaswamy Amar,
Parashar Akhil,
Agarwal Shikhar,
Modi Dhruv K.,
Poddar Kanhaiya L.,
Svensson Lars G.,
Roselli Eric E.,
Schoenhagen Paul,
Tuzcu E. Murat,
Kapadia Samir R.
Publication year - 2014
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25488
Subject(s) - medicine , lumen (anatomy) , femoral artery , receiver operating characteristic , valve replacement , complication , radiology , computed tomography , surgery , nuclear medicine , stenosis
Background Computed tomography (CT) imaging has not been systematically studied for predicting vascular complications during transcatheter aortic valve replacement (TAVR). Methods Clinical data were obtained from the electronic medical record and analysis was performed for each individual patient's iliofemoral CT angiogram. Sheath : femoral artery diameter ratio (SFAR) and sheath : femoral artery area ratio (SFAAR) were defined as the ratio of the sheath outer diameter to the femoral minimal lumen diameter (MLD) and sheath area to the femoral minimal lumen area (MLA), respectively. Results A total of 255 patients underwent TF‐TAVR with a 30‐day mortality of 0.4% and 30‐day stroke rate of 1.6%. Twenty‐eight (11%) patients suffered a vascular complication, the majority of whom (82%) were managed percutaneously. Receiver operating characteristic (ROC) curve analysis demonstrated an SFAAR of 1.35 to predict the occurrence of vascular complications with a sensitivity of 78.6%. By comparison, similar analysis using SFAR provided a value of 1.45 with sensitivity of 64.2%. Multivariable modeling confirmed SFAR [OR (95% CI): 8.3(1.8–39.1)] and log‐transformed SFAAR [OR (95% CI): 40.1 (2.4–650.0)] as significant predictors of vascular complication. Conclusions Using CT analysis, an SFAR of 1.45 and an SFAAR of 1.35 are each significant predictors of vascular complications among patients undergoing TF‐TAVR. Utilization of CT‐based area may provide a more accurate screen for patients undergoing evaluation for TF‐TAVR as it takes into consideration the elliptical nature of the vessel. © 2014 Wiley Periodicals, Inc.