Facilitating Safe Trans-femoral ACCESS for Transcatheter Aortic Valve Replacement in High Body Mass Index Patients—The FAST-ACCESS Cohort Study

Background: Transfemoral  (TF) access is the safest, quickest, and most studied access route for  transcatheter aortic valve replacement (TAVR).1  While TAVR has demonstrated excellent clinical outcomes, femoral access  site complications remain one of the most common adverse events of  TAVR,2 with attendant morbidity and even mortality.

Despite  contemporary safety refinements in obtaining wide-bore TF access (e.g.,  the routine use of vascular ultrasound and micropuncture), high body  mass index (BMI)3 and increased femoral arterial depth (FAD)4  are strong predictors of vascular complications during TF-TAVR. In such  high BMI patients, panniculus retraction (by a variety of  nonstandardized methods) may reduce the FAD and thus facilitate safer TF  access.

Locally, we have standardized this technique  by repurposed use of a dedicated adhesive panniculus retractor (APR)  device, initially designed for use in obese patients during caesarean  section. The FAST-ACCESS study reports our clinical experience using  this APR device during TF-TAVR in high BMI patients. Specifically, we  report (i) the reduction in FAD achieved using the dedicated APR device  and (ii) the vascular complication rate in consecutive patients with  high BMI undergoing TF-TAVR when using the dedicated APR device.