TCT-741 Comparison of long-term clinical outcome between patients with chronic versus acute type B aortic dissection treated by implantation of a stent graft: a single-center report Shao Liang Chen 1 1 Nanjing First Hospital, Nanjing Medical University, Jiangsu, China Background: Background: Stent grafting for treatment of type B aortic dissection has been extensively used. However, the difference in the long-term clinical outcome between patients with chronic versus acute type B aortic dissection remains unknown. This study aimed to analyze the difference in long-term clinical outcome after endovascular repair for patients with chronic ($2 weeks) versus acute (<2 weeks) type B aortic dissection. Methods: Between May 2000 and June 2011, a total of 174 patients with type B aortic dissection (56 chronic, 118 acute) treated by endovascular repair were studied prospectively. Follow-up three-dimensional computed tomography scanning and aortoangiography were scheduled at 3–6 months after the index procedure. Propensity score matching was used to compare the difference in the endpoint between the two groups. Results: The procedure-related event rate was 18.6% in the acute group and 5.4% in the chronic group (P ¼ 0.021), but this difference became nonsignificant after propensity score matching. At the end of follow-up (mean 2.49 years), overall and aorta-related mortality was 11.0% and 7.6%, respectively, in the acute group, and was not significantly different from that in the chronic group (3.6% and 3.6%, P ¼ 0.148 and P ¼ 0.506, respectively). Both false and true lumina showed significant remod- eling over time, with .93% complete false-lumen thrombosis. Untreated tear and type I endoleak were predictors of clinical events during follow-up. Conclusions: Comparable long-term clinical results were achieved in patients with chronic or acute type B aortic dissection after implantation of a stent graft. TCT-742 Lower Vascular Complications With Percutaneous versus Open Transfemoral Transcatheter Aortic Valve Replacement Mitul B. Kadakia 1 , Howard C. Herrmann 2 , Nimesh Desai 3 , Zachary E. Fox 1 , Jeffrey Ogbara 1 , Saif Anwaruddin 1 , Dinesh Jagasia 1 , Joseph E. Bavaria 1 , Wilson Y. Szeto 4 , Prashanth Vallabhajosyula 1 , Rohan Menon 1 , Jay Giri 1 1 Hospital of the University of Pennsylvania, Philadelphia, PA, 2 Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, 3 Penn Medicine, Philadelphia, PA, 4 University of Pennsylvania Medical Center, Philadelphia, Pennsylvania Background: Transcatheter aortic valve replacement (TAVR) via the transfemoral (TF) approach is currently performed by both open surgical and percutaneous access. Vascular complications are associated with morbidity and mortality, but few studies have directly compared access approach. Methods: Data was collected on all patients undergoing TF TAVR with Sapien or Sapien XT aortic bioprostheses (Edwards Inc., Irvine, CA) between November 2007 and April 2013 at our institution. Valve Academic Research Consortium definitions were utilized. Results: TF TAVR was performed in 331 patients via an open surgical (n¼120) or percutaneous (n¼211) approach. Both groups were similar in age, however the open group had a greater incidence of cardiovascular comorbidities. The average sheath outer diameter (OD) was slightly larger in the open group as compared to the percutaneous group (8.6  0.4 vs. 8.4  0.6 mm, p<0.001). There were fewer major vascular complications in the percutaneous as compared to the open group (11% vs. 20%, p¼0.03), and a trend toward fewer overall vascular complications (17% vs. 26%, p¼0.06). More patients with vascular complications in the percutaneous cohort had minimal artery diameter (MAD) less than sheath OD (74% versus 55%, p¼0.03). The percutaneous group had decreased length of stay (LOS) compared to the open group (7.5  4.7 vs. 9.9  9.9 days, p¼0.003). There was no difference in in-hospital mortality between the open and percutaneous groups (2.5 % vs. 1 %, p¼0.36). The use of second generation TAVR sheaths and valves via a percutaneous approach was associated with an even greater reduction in vascular complications (8% vs. 25%, p¼0.01) and LOS (7.0  4.8 versus 10.1  10.0 days, p¼0.04) as compared to the open group with first generation devices. Despite an increase in the difference between sheath OD and MAD (-0.21 vs. 0.27 mm, p¼0.02) in the first and second half of our percutaneous access experience, the rates of vascular complications did not change over this time. Conclusions: TF TAVR via a percutaneous approach is associated with less vascular morbidity and lower LOS as compared to an open surgical approach. These benefits are even greater with second-generation (Sapien XT) devices. TCT-743 Stratification of survival after transcatheter aortic valve replacement based on vascular complication by VARC-1 or VARC-2 criteria Kazuaki Okuyama 1 , Hasan Jilaihawi 1 , Mohammad Kashif 1 , Omar R. Sadruddin 1 , Jigar Patel 1 , Vikas Soni 1 , Heera Pokhrel 1 , Tarun Chakravarty 2 , Mamoo Nakamura 1 , Raj Makkar 1 1 Cedars-Sinai Medical Center, Los Angeles, CA, 2 Cedars Sinai Medical Center, Los Angeles, CA Background: Valve academic research consortium (VARC) guidelines were devised in an effort not only to standardize clinical endpoint definitions but also to select endpoints that best reflect the safety and efficacy of transcatheter aortic valve replacement (TAVR). These guidelines are evolving in an expert led manner. We sought to compare the predictive value for survival of major vascular complications (VC) by VARC-1 and 2 definitions. Methods: A large single center series of patients undergoing TAVR by multiple approaches were studied. We defined VC according to VARC-1 and VARC-2 defi- nition, and compared the mortality one year after the procedure. Data was analyzed using Kaplan-Meier (KM) and Cox regression multivariable models that included all variables related to 1-year mortality to a significance level0.1. Results: Data was analyzed for 388 patients. KM curves showed a numerically lower survival rate at 1-year by major VC with both definitions, but only VARC-2 had statistical significance; 79.2% vs. 60.7% with VARC-2 (p ¼0.015), and 78.8% vs. 70.5% with VARC-1 (p ¼ 0.211). Cox regression multivariable model showed VC by VARC-2 definition to be an independent predictor of 1-year mortality (p ¼ 0.004), but not when VC was substituted by the VARC-1 definition (p¼0.08). Conclusions: The VARC-2 definition for vascular complications offers better strati- fication of survival than the VARC-1 definition, supporting its widespread use. Reasons for this important difference will be discussed. TCT-744 Quantitative Assessment of Balloon-Expandable Valve Position During Transcatheter Aortic Valve Replacement Using Intraoperative Transesophageal Echocardiography Leo Marcoff 1 , Omar K. Khalique 1 , Susheel Kodali 1 , Mathew Williams 1 , Tamim Nazif 1 , Jean-Michel Paradis 1 , Isaac George 1 , Martin Leon 2 , Rebecca Hahn 1 1 Columbia University, New York, NY, 2 Cardiovascular Research Foundation, New York, NY Background: Although prior studies describe the fluoroscopic operator-independent motion of the balloon-expandable valve, no studies have described the trans- esophageal echocardiogram (TEE) appearance of valve deployment. Methods: Intraoperative TEE from 100 consecutive* patients presenting for TAVR were retrospectively analyzed. Patients with unreliable pacemaker capture or obvious operator-induced device motion during deployment were excluded (n¼16). Device position was defined as the percent of total device height below the virtual annulus (hinge points of aortic valve cusps). Device position was measured pre-deployment (during rapid pacing) and post-deployment. Device cranial movement during deployment was defined as the difference between the pre-deployment and post- deployment position (in mm) of the valve midpoint. TUESDAY, OCTOBER 29, 2013, 3:30 PM–5:30 PM www.jacctctabstracts2013.com B226 JACC Vol 62/18/Suppl B j October 27–November 1, 2013 j TCT Abstracts/POSTER/Aortic Valve Disease and Treatment POSTERS