SPC365

Secondary Access in TAVR: Enhancing Safety and Simplifying Vascular Complications Resolution

Session: Sessão de Posters 26 - TAVI: acessos vasculares
Speaker: Tatiana Pereira dos Santos

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Tatiana Pereira Dos Santos; Gonçalo Terleira Batista; Mariana Rodrigues Simões; Ana L. Silva; Joana Guimarães; Vanessa Lopes; Rafaela Fernandes; Diogo Fernandes; Vera Marinho; Elisabete Jorge; Marco Costa; Lino Gonçalves

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="color:#333333">BACKGROUND: The number of patients undergoing transcatheter aortic valve replacement (TAVR) has increased significantly. Access site complications are an important measure of the safety of these procedures. Complications can result in potentially life-threatening situations. Regarding the secondary access, it is controversial whether the contralateral femoral artery should be used as the standard approach or, for safety reasons, operators should switch to radial access.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:#333333">AIM:</span></span></span><span style="font-size:10.0pt"><span style="color:#333333"> To analyze the complications rates of secondary access sites and closure devices in patients undergoing TAVR for severe aortic stenosis and its possible impact on mortality.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:#333333">METHODS: </span></span></span><span style="font-size:10.0pt"><span style="color:#333333">We retrospectively analyzed<span style="background-color:white"> all patients who underwent TAVR in a Portuguese tertiary center between March 2020 and June 2023. W</span>e then assessed vascular complications associated with secondary access<span style="background-color:white">. </span>Echography guidance was employed for all arterial punctures.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:#333333">RESULTS: Of the 579 patients who underwent TAVR, the median age was 82 years (IQR 7), 51.3% were male,84.5% had hypertension and 35.1% diabetes. For the TAVR procedure, 97.5% used mainly transfemoral (6 French) as secondary access. The </span></span></span><span style="font-size:10.0pt"><span style="color:#333333">remainder <span style="background-color:white">included: 1.8% radial artery, 0.7% brachial artery. Secondary site closing devices were mainly </span>Angio-Seal&reg;<span style="background-color:white"> in 66.2% and </span>Mynx Control&trade; in <span style="background-color:white">18.1%. Other methods included: </span>ProGlide&trade;<span style="background-color:white"> in 8.7%,</span> ObturaTM<span style="background-color:white"> in 0.2%, mechanical compression (</span>TR Band&trade;<span style="background-color:white">3.1% and </span>FemoStop&trade; <span style="background-color:white">0.2%) and manual compression. Major vascular complications from the secondary access were very rare, with only three patients presenting with pseudoaneurysm (0.5%). Minor complications as hematomas didn&rsquo;t need any specific intervention. However, regarding the primary access site, more complications were observed. In 23 patients (4%), complication as arterial occlusion (30.4%), bleeding (39.1%), pseudoaneurysm (8.7%), hematoma (4.3%), dissection (4.3%), perforation (8.7%) and guide wire loss (4.3%) were found. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="color:#333333">CONCLUSIONS: Given the rare occurrence of vascular complications linked with secondary femoral access, likely attributable to echo-guided arterial punctures, the transition to radial access as the default strategy remains a matter of debate. However, complications arising from the primary access are more prevalent and typically addressed through contralateral transfemoral access. Consequently, the use of a secondary femoral access doesn&rsquo;t appear to compromise overall safety and may streamline the resolution of complications linked to the primary access.</span></span></span></span></p>