The Iliofemoral tortuosity score predicts access and bleeding complications during transfemoral transcatheter aortic valve replacement: DataData from the VIenna Cardio Thoracic aOrtic valve registrY (VICTORY)

BACKGROUND

Arterial tortuosity is linked to a higher risk of adverse clinical events after transfemoral transcatheter aortic valve replacement (TF-TAVR). Currently, there are no assessment tools that can quantify this variable in three-dimensional space. This study investigated the impact of novel scoring methods of iliofemoral tortuosity on access and bleeding complications after TF-TAVR.

METHODS

The main access vessel was assessed between the aortoiliacal and femoral bifurcation in preoperative multislice computed tomography scans of 240 consecutive patients undergoing TF-TAVR. Tortuosity was assessed by three methods: largest single angle, sum of all angles, and iliofemoral tortuosity (IFT) score [((true vessel length/ideal vessel length)-1)*100]. The primary study endpoint was a composite of access and bleeding complications. The secondary study endpoints were 30-day mortality and long-term survival.

RESULTS

Among 240 patients, only the IFT score demonstrated a good positive correlation with the composite primary endpoint of access and bleeding complications (P = 0.031). A higher incidence of access and bleeding complications was found in patients with a higher IFT score (56 [36.8%] vs 17 [19.3%]; P = 0.003). In a multivariate logistic regression analysis, only the IFT score was a significant predictor of the primary endpoint (OR: 2.11; 95% CI: 1.09-4.05; P = 0.026).

CONCLUSION

Vascular tortuosity is an underestimated risk factor during TF-TAVR. The IFT score is a valuable tool in risk stratification before TF-TAVR, predicting periprocedural access and bleeding complications.

Transcatheter closure of patent foramen ovale for the secondary prevention of decompression illness in professional divers: a single-centre experience with long-term follow-up

BACKGROUND

Patent foramen ovale (PFO) with occasional right-to-left shunting is associated with an increased risk of decompression illness (DCI). Divers with a history of repetitive or severe DCI and diagnosed with PFO should be considered for transcatheter closure if they wish to continue with unrestricted diving.

AIM

To summarise our centre's experience in transcatheter PFO closure in professional divers with a history of DCI.

METHODS

A follow-up of 11 consecutive divers (nine males, two females) in whom device PFO closure was performed between 2001 and 2015 was carried out by phone contact. Available medical records and diving logbooks were reviewed to determine individual DCI symptomatology, indications to the procedure, and to evaluate modifications in the diving practice.

RESULTS

Each patient experienced at least one event of DCI before the procedure, and eight patients experienced more than one event. Total number of reported events was 62. The vast majority of events (97%) followed dives consistent with safe decompression policies. The median follow-up was 91 (minimum nine, maximum 172) months. No complications of the intervention were observed. All patients returned to unrestricted, deep diving, performing a total of 3610 dives with the median number of 225 dives (lower quartile value: 82.5 dives, upper quartile value: 725 dives). The majority of subjects dived as deep as they did before the intervention, or deeper, achieving mean maximum depth of 93.8 ± 35.6 m (vs. 89.7 ± 25.9 m before the intervention, p = 0.71). No episodes of DCI were reported during the follow-up period.

CONCLUSIONS

Transcatheter closure of PFO appears to be reasonably effective in secondary prevention of DCI associated with intra-cardiac shunting.