SPC365

The impact of echo-guided vs fluoroscopic femoral access puncture on transcatheter aortic valve implantation-related vascular complications

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: Inês Rodrigues

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Posters
FP Number: ---
Authors: Inês Rodrigues; Cláudio Guerreiro; Alberto Rodrigues; Bruno Melica; Lino Santos; Gustavo Pires de Morais; Pedro Braga; Francisco Sampaio

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction and Objectives:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> Transcatheter&nbsp; aortic valve implantation (TAVI) is an increasingly used technique, but vascular and bleeding access-related complications are still common in this procedure. The use of ultrasound guidance for femoral artery puncture can help reduce its occurrence. The objectives of this study were: 1) to evaluate the impact of echo-guided access site puncture&nbsp;on TAVI-related vascular and bleeding complications and 30-day mortality and (2) to identify the predictors of these outcomes.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Patients who underwent transfemoral TAVI between January and December 2017 (fluoroscopic-guided access) and between June 2018 and May 2019 (echo-guided access) were included in this study. Comparisons were made between both groups regarding vascular and bleeding complications, as defined by the VARC2 criteria, and 30-day mortality. Two additional composite endpoints were also defined: 1) any vascular or bleeding complications; and 2) any vascular or bleeding complications or the need for transfusion of at least two units of red blood cells (URBC).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: 230 patients were included (112 fluoroscopic-guided; 118 echo-guided access puncture). Haemorrhage (24,3% vs 9,4%, p=0,003), vascular complications (27,7% vs 16,9%, p=0,05) and 30-day mortality (13,9% vs 1,8%, p=0,001) were more&nbsp;common with the fluoroscopic-assisted technique. After adjustment for clinical and procedural significant variables,&nbsp; the use of echo-guided access was an independent predictor of less haemorrhage (OR=0,408, 95% CI 0,170-0,82, p=0,045) and of the composite of any vascular or bleeding complication or the need for transfusion of &ge; 2 URBC (OR=0,509, IC95% 0,264-0,979, p=0,043). Regarding vascular complications as an isolated endpoint, only BMI was found&nbsp;as an independent predictor&nbsp; (OR 0,47, 95% CI 0,23-097, p=0,04).&nbsp; A BMI value of 26,64 kg/m</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">&nbsp; was the best cut-off to</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#ff0000"> </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">predict vascular complications (S 78%, E 55%, AUC 0,666), offering greatest protection above this value (p&lt;0,001). Concerning 30-day mortality, access-site puncture method did not remain a predictor after adjusting for EuroSCORE II.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: The introduction of echo-guided access-site puncture in TAVI procedures&nbsp;reduced TAVI-related vascular and bleeding complications and 30-day mortality, and it was an independent predictor of less haemorrhage and of the composite of any vascular or bleeding complication or the need for transfusion Interestingly, BMI proved to be the most important protective factor of vascular complications, possibly highlighting the obesity paradox associated with TAVI procedures.</span></span></span></p>