Multi-Pigtail Technique is Associated with Decreased Contrast Use and Fluoroscopic Adjustment for Transcatheter Aortic Valve Replacement

Background: Successful TAVR is partly determined by deploying the valve in the perpendicular angle of deployment (PAOD), which is in a 90-degree plane to the aortic annulus. Preprocedurally, the PAOD is predicted with multi-detector-computed tomography (MDCT). Intra-procedurally, one or more pigtail catheters are placed in the aortic annulus and an aortogram is used to corroborate the predicted PAOD. However, this often shows a non-PAOD necessitating fluoroscopic adjustments. We compared outcomes in patients undergoing TAVR with a one-pigtail (OP) or multi-pigtail (MP) technique. Methods: 283 TAVR patients were retrospectively analyzed from 2015 to 2017. 42% (n = 118) of the patients underwent an OP technique and 58% (n = 165) used an MP technique. We reviewed demographics, procedural characteristics, and major adverse cardiovascular events (MACE). Results: Patients in the MP group had decreased fluoroscopy time, contrast dose, and time to valve deployment (17.8 ± 8.7 vs 23.5 ± 13.6 20 min, p = 0.0000; 74.8 ± 39.8 vs 117.3 ± 59 cc, p = 0.0000; and 22.6 ± 9.4 vs 27.1 ± 13.1 min, p = 0.0011, respectively). There was no difference in MACE. Using multivariate linear regression with adjustment for differing baseline characteristics, MP use was independently associated with reduced contrast volume (ß –34; 95% CI –50 to –18; p = 0.001) and fluoroscopy time (ß –4.4; 95% CI –8.0 to –0.6; p = 0.022). Conclusions: In this single center retrospective study, use of an MP technique was associated with significantly decreased time to deployment, fluoroscopy time, and contrast dose in patients undergoing TAVR.