{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T14:42:23Z","timestamp":1747147343871,"version":"3.40.5"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T00:00:00Z","timestamp":1715472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In transcatheter aortic valve replacement (TAVR),\u00a0transfemoral (TF) access offers several advantages over alternative access routes. Advances in sheaths and valve delivery technology have catalyzed the feasibility of TF\u2010TAVR, even in challenging anatomies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>Report procedural characteristics and outcomes of a TAVR program aiming for a 100% TF access rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive patients undergoing TAVR were enrolled in a prospective registry. Equipment used to facilitate TF\u2010access in challenging anatomies included low\u2010profile sheaths, dilatators, peripheral balloons, covered and uncovered self\u2010expanding\u00a0and balloon\u2010expandable stents, and intravascular lithotripsy (IVL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 400 patients with a mean age of 81\u2009\u00b1\u20096 years (42% female) were analyzed. Minimal iliofemoral artery diameter (MLD) of the main access side was &lt;5\u2009mm in 42 (10.5%), extreme tortuosity was present in 65 (16.3%), and severe calcification in 59 (14.8%). TF\u2010access was successful in 399 (99.8%) patients. A transaxillary access was used in one patient. In multivariable analysis, an MLD\u2009&lt;\u20095\u2009mm was the strongest predictor for vascular complications (11.9% vs. 3.9%, OR: 3.86, 95% CI: 1.38\u221210.8, <jats:italic>p<\/jats:italic>\u2009=\u20090.01). Such patients also had more major\/life\u2010threatening bleeding (14.2% vs. 3.1%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and required more planned and unplanned peripheral interventions to enable TF\u00a0access (35.8% vs. 3.4%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study shows that utilization of dedicated sheaths, peripheral balloons, stents, and IVL enables TAVR via TF access in &gt;99% of patients. However, rates of vascular and bleeding complications in patients with narrow iliofemoral arteries (MLD\u2009&lt;\u20095\u2009mm) were high.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.31077","type":"journal-article","created":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T05:33:53Z","timestamp":1715578433000},"page":"134-144","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Transfemoral\u2010only transcatheter aortic valve replacement: A single center experience of 400 consecutive patients"],"prefix":"10.1002","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5794-5676","authenticated-orcid":false,"given":"Federico","family":"Moccetti","sequence":"first","affiliation":[{"name":"Heart Center Lucerne, Cardiology Luzerner Kantonsspital Lucerne 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