SPC365

Transcatheter Aortic Valve Implantation percutaneous alternative access routes outcomes

Session: Posters (Sessão 4 - Écran 6) - Intervenção Valvular Aórtica Percutânea 1
Speaker: André Grazina

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: André Grazina; Bárbara Lacerda Teixeira; Alexandra Castelo; André Ferreira; Tiago Mendonça; Inês Rodrigues; Luis Almeida Morais; Tiago Pereira-Da-Silva; Ruben Ramos; António Fiarresga; Lino Patrício; Rui Cruz Ferreira; Duarte Cacela

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction:</span></strong> <span style="background-color:white"><span style="color:black">Transfemoral (TF) access is globally accepted as the preferential route for transcatheter aortic valve implantation (TAVI). </span></span>Despite technique experience and miniaturization of the new-generation transcatheter heart valves (currently using 14-16 French sheaths), registries describe impossibility of the TF access in up to 15% of patients, mainly due to extensive calcified peripheric arterial disease or unfavorable anatomy. From the several alternative access routes, the fully percutaneous routes have been chosen preferentially, as the trans-subclavian (TS), transcarotid (TC) and transcaval (TCv) accesses. Currently, there are no randomized clinical trials comparing these different approaches. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Objectives:</span></strong><span style="color:black"> This analysis aims to compare outcomes and complications of transfemoral, trans-subclavian and transcaval access routes for TAVI.</span></span></span></p>

<h1 style="text-align:justify"><span style="font-size:24pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"><strong>Methods:</strong> </span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Retrospective analysis of patients submitted to TAVI using TF, TS and TCv accesses in a single tertiary center. The primary endpoints were 30-day and 1-year all-cause mortality and assessed using a Kaplan-Meier analysis. The secondary endpoints were technical success, residual moderate to severe perivalvular leak, major vascular complication, 30-day stroke, 30-day major bleeding (according to VARC-2 criteria) and 30-day acute Kidney Injury (AKIN criteria 2 or 3). </span></span></span></span></span></h1>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Results:</span></span></strong> <span style="background-color:white"><span style="color:black">642 TAVI procedures were performed (601 transfemoral, 24 trans-subclavian and 10 transcaval) and 7 were excluded for using a transapical access. Regarding baseline characteristics, mean age, severity of aortic stenosis and valvular calcification </span></span><span style="background-color:white"><span style="color:black">were similar between the groups. The presence of left ventricular dysfunction and coronary artery disease was higher in the TS and TCv groups, the prevalence of atrial fibrillation and chronic kidney disease was higher in the TS group and the prevalence of previous stroke was higher in the TCv group. 1-year and 30-day all-cause mortality was similar between the TS and TCv groups (p 0.649 and p 0.273). TF access patients have lower mortality rates than TCv patients at 30 days (HR 6.26, p 0.001) and lower mortality rates than TS patients at 1 year (HR 3.15, p 0.001). 30-day stroke and acute kidney injury (AKIN 2 or 3) rates were significantly lower in the TF patients, but similar between TS and TCv patients. 30-day major bleeding rates showed a statistical tendency to lower rates in the TF group. Technical success, major vascular complication and residual moderate or severe perivalvular leak rates were similar between the three groups.&nbsp; </span></span>&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Conclusions:</span></span></strong> <span style="background-color:white"><span style="color:black">This analysis enhances the role of the transfemoral access as the preferential route for TAVI procedures. Regarding alternative access routes, both the trans-subclavian and transcaval have showed to be feasible with reasonable results, once the poorer outcomes when compared with the transfemoral patients can be partially explained by worst baseline characteristics.</span></span></span></span></p>