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

Aims: 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 iliofemoral angiography as an initial screening tool for TAVR using the transfemoral approach with the Edwards SAPIEN valve. Methods and results: 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. Conclusions: 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.