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Unilateral femoral access for transcatheter aortic valve implantation
Session:
Posters (Sessão 5 - Écran 5) - Intervenção Valvular Aórtica Percutânea 2
Speaker:
André Paulo Ferreira
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 Paulo Ferreira; Bárbara Teixeira; André Grazina; Francisco Albuquerque; Alexandra Castelo; Tiago Mendonça; Inês Rodrigues; António Fiarresga; Rúben Ramos; Rui Cruz Ferreira; Duarte Cacela
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Background: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">In transcatheter aortic valve implantation (TAVI) procedures most operators place a second arterial sheath in the contralateral femoral artery to perform aortic root angiography and hemostasis confirmation.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Purpose: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">The aim of this study was to compare the safety and success of TAVI procedures when placing a second arterial sheath ipsilateral to the delivery sheath.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Methods: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">Retrospective analysis of patients submitted to transfemoral (TF) TAVI in a single tertiary center between January 2021 and October 2022 using unilateral (UL) and bilateral (BL) access approaches. Baseline characteristics, procedure data, and outcomes were noted according to the Valve Academic Research Consortium-2 (VARC-2). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Results:</span></span></strong><strong> </strong><span style="font-size:11.0pt"><span style="color:black">A total of 242 patients underwent TF-TAVI during the study period, including 68 patients (mean age 82.1±6.13 years, 61.2% male) that underwent TF-TAVI using a UL femoral access. Regarding the latter baseline characteristics, it was noted a mean Euroscore II of 2.95±1.91 and STS score of 4.18±2.72, a basal NYHA class of 2.74±0.60, obstructive coronary artery disease in 29.7% of patients (previous myocardial infarction in 8.1%, and previous CABG in 8.1%), peripheral artery disease in 13.5%, and previous stroke in 2.9%. There were no significant differences in major vascular complications (5.9% vs 5.6%, p=0.877) or access-related complications (7.4% vs 4.9%, p=0.755) between UL and BL access approaches. Unilateral access major vascular complications were comprised of an aortic rupture, a retroperitoneal hematoma, and two access hematomas leading to major bleeding. In-hospital mortality in the UL group was 2.94% (one patient died due to aortic rupture and another died of unrelated head trauma), which compares favorably with the 4.0% in-hospital mortality in the BL group. Bleeding events (11.8% vs 7.5%, p=0.636), stroke (2.9% vs 3.4%, p=0.639), acute myocardial infarction (0% vs 1.7%, p=0.552), and permanent pacemaker implantation rates (13.2% vs 16.7%, p=0.138) were also similar between both groups. VARC-2 composite endpoint of device success rate was 97.1% in the UL group vs 98.4% in the BL group (p=0.607), and the composite endpoint of early safety at 30 days was 90.6% in the UL group vs 85.8% in the BL group (p=0.202). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Conclusion: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">This analysis describes an early experience with unilateral femoral access for TF-TAVI regarding the technique complications, safety, and outcomes. Unilateral access procedures provided similar safety and efficacy when compared with bilateral access.</span></span></span></span></p>
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