The safety and efficacy of temporary distal aortic occlusion to facilitate TAVR large-bore arterial closure.

OBJECTIVES: To evaluate the safety and efficacy of temporary distal aortic occlusion (TDAO) for facilitated large-bore arterial closure during transcatheter aortic valve replacement (TAVR). BACKGROUND: Ipsilateral iliac artery occlusion and TDAO have been used to facilitate TAVR delivery sheath access-site closure, but ipsilateral iliac artery occlusion has been associated with arterial complications at the balloon site. METHODS: TDAO was performed in 117 consecutive transfemoral TAVR cases from July 2010 to April 2012. The valve delivery access site was preclosed with suture-mediated closure devices (n = 100) or had a planned surgical cutdown performed (n = 17). TDAO was performed using a 22 mm x 5 cm Tyshak II balloon, which was deployed at the minimum pressure to stop antegrade blood flow in the distal abdominal aorta via a contralateral 8 Fr femoral sheath. This served to occlude iliac run-off as the TAVR delivery sheath access site was closed. Final aortogram with bilateral run-off was performed to evaluate for aortic, iliac, or femoral dissection or rupture, or ilio-femoral vascular complications in accordance with Valve Academic Research Consortium (VARC)-2 criteria. RESULTS: TDAO was successfully performed in all patients with no complications related to the TDAO technique itself. There were vascular complications related to the TAVR procedure. 7 patients (6.0%) had VARC-2 major vascular complications and 16 patients (13.7%) had VARC-2 minor vascular complications. CONCLUSIONS: TDAO is a safe and effective technique to facilitate large-bore arterial closure by both percutaneous and open surgical closure techniques.