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Is iliofemoral calcium volume associated with vascular and bleeding complications after TAVI?
Session:
Posters (Sessão 5 - Écran 7) - Intervenção Cardíaca Coronária e Estrutural 3 - Foco na Válvula Aórtica
Speaker:
Mariana Ribeiro Silva
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana Ribeiro Silva; Joana Oliveira; Inês Rodrigues; Cláudio Guerreiro; Wilson Ferreira; Nuno Ferreira; Gustavo Pires Morais; Bruno Melica; Lino Santos; Alberto Rodrigues; Pedro Braga; Francisco Sampaio; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Pre-procedural iliofemoral computed tomography angiography (CTA) study and the use of ultrasound guidance for femoral artery puncture can reduce vascular (VC) and bleeding (BC) access site complications after transfemoral (TF) TAVI. However, is yet to be proven that CTA-derived iliofemoral calcium volume is associated with VC and BC following TF TAVI.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives: </strong>To assess the impact of iliofemoral calcium volume and distribution, as evaluated </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">by CTA, in VC and BC after TF TAVI.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Patients (pts) who underwent TF TAVI between January and December 2017 (fluoroscopy-guided access) and between June 2018 and May 2019 (echo-guided access) were included. All pts underwent iliofemoral CTA prior to the procedure and classical CTA-derived data and iliofemoral calcium volume ipsilateral to the puncture site were collected to evaluate its impact on VC and BC, which were defined by Valve Academic Research Consortium 2 criteria.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We included 221 pts, 51,6% female, mean age 80,4±7,8 years and median STS mortality risk score of 3,9% (IQR 2,6-6,1). Right TF access was obtained in 84,2%; 47,5% fluoroscopy and 52,5% echo-guided access, with a sheath size >14Fr in 43%.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">VC occurred in 49 pts (22,2%) (18,6% minor, 3,6% major) and BC in 36 pts (16,3%) (13,6% minor, 2,2% major, 0,5% life-threatening). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">There was a significant lower prevalence of VC (16,4% vs 28,6%, p=0,029) and BC (8,6% vs </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">24,8%, p=0,001) in the echo-guided group.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Iliofemoral CTA qualitative assessment of calcium quantity, distribution (anterior vs posterior) and tortuosity was not different between pts with or without VC or BC. Univariate analysis showed that external iliac artery (EIA) and common femoral artery (CFA) luminal minimal diameter and area, CFA maximal luminal diameter were significantly smaller in pts with VC and BC (p<0,05 for all). Sheath to external iliac artery ratio (SEIAR) and sheath to femoral artery ratio (SFAR) were higher in pts with VC and BC (p<0,05 for all).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">There were no significant differences in CTA-derived total Iliofemoral calcium volume, EIA and CFA calcium volume between pts with or without VC and BC (p>0,05 for all).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>Echo-guided access reduced TAVI-related VC and BC. In this study,<strong> </strong>iliofemoral calcium volume was not associated with VC and BC after TAVI, while other classical CTA-derived factors such as SEIAR, SFAR, EIA and CFA minimal diameter and area were, and should be systematically assessed during pre-procedural CTA to reduce these events. </span></span></p>
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