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Contemporary management and outcomes of patients with vascular complications during transfemoral TAVI.
Session:
Posters (Sessão 5 - Écran 7) - Intervenção Cardíaca Coronária e Estrutural 3 - Foco na Válvula Aórtica
Speaker:
Francisco Albuquerque
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Francisco Albuquerque; Daniel a. Gomes; Rui Campante Teles; Pedro Lopes; Mariana Gonçalves; Afonso Félix de Oliveira; João Brito; Luís Raposo; Silvio Leal; Henrique Mesquita Gabriel; Pedro de Araújo Gonçalves; Manuel de Sousa Almeida; Miguel Mendes
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>[BACKGROUND]:</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">Vascular complications (VC) after transcatheter aortic valve implantation (TAVI) are associated with increased mortality and morbidity. The aim of this study was to report the incidence, management, and impact on outcomes of VC in patients undergoing transfemoral TAVI. </span></span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>[METHODS]:</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Observational single center study from a prospective registry including 668 consecutive patients who underwent transfemoral TAVI between january 2016 and December 2020 (median age = 84 [IQR 81-87], 26.7% male; median EuroSCORE II of 4.11 % [IQR 3.11 – 6.18]). Vascular complications were defined according to Valve Academic Research Consortium-3 criteria. VC endovascular treatment success was defined as residual stenosis < 30%, absence of blood extravasation assessed by fluoroscopy and no need for surgical or endovascular intervention at 30 days</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>[RESULTS]:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Overall, 99/668 patients (14.8%) experienced at least one VC (105 in total), including 60/668 patients (9.0%) experiencing at least a major VC. VCs included 25/105 (23.8%) acute iliofemoral bleeding, 22/105 (21.0%) femoral artery occlusions, 50/105 (47.6%) retroperitoneal hematoma/ilioinguinal hematoma and 8/105 (7.6%) femoral pseudoaneurysms. Endovascular treatment during the index procedure was performed in 47/105 (44.8%) patients and successful in most (93.6%) cases. Management strategy according to VC type and VC severity are presented in <strong><span style="color:#4472c4">table 1. </span></strong><span style="color:black"> Primary surgical repair was necessary in 3/47 patients (6.4%), for iliofemoral bleeding control in all cases. </span>Patients with major VC had higher 30-day and 1-year mortality rates (OR [95% CI]: 15.2 [5.42 – 42.4], <em>p</em> < 0.001; 3.3 [1.68 – 6.3], p < 0.001, respectively). </span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>[CONCLUSIONS]:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">Major vascular complications following transfemoral-TAVI are frequent, impact prognosis and occur in nearly 1 out of 10 patients (9.0%). When needed, percutaneous techniques are successful in most cases. Strategies to mitigate this serious event should be implemented. </span></span></span></span></p> <p> </p>
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