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Secondary access for TAVI: radial or femoral artery in minimalist TAVI?
Session:
Painel 10-Doença Valvular 2
Speaker:
Francisco Albuquerque
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Francisco Albuquerque; Afonso Félix De Oliveira; Rui Campante Teles; Gustavo Mendes; João Brito; Henrique Gabriel; Pedro de Araújo Gonçalves; Luís Raposo ; Mariana Gonçalves; Tiago Nolasco; Manuel Almeida; Miguel Mendes
Abstract
<p><strong>Introduction: </strong>A radial artery (RA) secondary access has been proposed for minimalist TAVI. Improved patient comfort and decreased bleeding risk are theoretical advantages. However, its use has been limited due to concerns regarding the performance of bailout interventions on femoral main access. This study aimed to describe the safety and efficacy with radial artery secondary access.</p> <p><strong>Methods and population: </strong>We performed a single center prospective cohort study of 298 consecutive patients undergoing transfemoral TAVI (TF-TAVI) from 2018-2019. RA access was progressively introduced during the study period, therefore a retrospective analysis with 1:1 propensity-score (PS) matched population was derived based on age, female sex, BMI, EuroScore II, pre-procedure hemoglobin, vascular closure device of the main access and Sheath-to-Femoral artery (SFa) ratio. A total of 250 matched patients (125 Radial vs 125 Femoral) were included. Median age was 84 (IQR 80-87), median ESII 4.2 (IQR 3.0-6.2) and 43.2% were male. The variables used in the PS were successfully balanced. The primary endpoint was the occurrence of major or life-threatening bleeding (VARC-2 definition) and the secondary were successful percutaneous bailout interventions (balloon and/or stent) on the main access.</p> <p><strong>Results: </strong>In the RA group, left side was used as the preferred approach (n = 115, 92%). The event rate of the primary endpoint was low in both groups (RA – 7 patients, 5.6% vs FA – 5 patients, 4.0%, p=0.77). The incidence of the secondary endpoint was also low (RA – 9 patients, 7.2% vs FA – 10 patients, 8.0%, p=1.000). Of note, in the patients from the RA group who needed a bailout intervention, a balloon-only angioplasty was performed in 4 patients and a stent was deployed in 5 patients. A total of 5 patients needed to be converted from a radial to femoral access (a single one required vascular surgery). Thus, the success rate of percutaneous bailout intervention was 88% for radial (8/9) and 100% with femoral artery (10/10).</p> <p><strong>Conclusion: </strong>Radial artery secondary access presented safe and efficacy. This minimalist approach should be tested in larger randomized trials.</p>
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