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Vascular complications after transfemoral transcatheter aortic valve implantation in patients with small peripheral vessels
Session:
Sessão de Posters 26 - TAVI: acessos vasculares
Speaker:
Ana Inês Aguiar Neves
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:
Ana Inês Aguiar Neves; Marta Leite; Rafael Teixeira; Fabio Nunes; Marta Catarina Almeida; André Lobo; Gustavo Pires de Morais; Bruno Melica; Lino Santos; Alberto Rodrigues; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Introduction: </strong>The transfemoral route is the most frequently employed option for transcatheter aortic valve implantation (TAVI). We aimed to characterise a population of patients with small peripheral vessels who underwent TAVI in a high-volume centre and determine factors associated with vascular complications and all-cause mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Methods: </strong>Clinical and computerized tomography angiography (CTA) data was collected from a selection of 209 patients undergoing transfemoral TAVI between January and December 2017 (fluoroscopy-guided access) and between June 2018 and May 2019 (ultrasound-guided access). Small peripheral vessels were defined by a common femoral artery with a minimal luminal diameter (MLD) of ≤5.5 mm on CTA imaging.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Results: </strong>In this study, 122 patients (58% of all patients; 63% women; mean age 83±5 years; median EuroScore II 4.4±2.4; median STS mortality score 4.5±2.1) had a common femoral artery MLD of ≤5.5 mm. Patients with small peripheral vessels were more likely to be female (63% vs. 38%, p < 0.001), have lower body mass index (27.4 vs. 25.9, p = 0.004), have higher STS mortality scores (3.38 vs. 4.47, p = 0.010) and have anaemia (57% vs. 38%, p = 0.007); they were less likely to have chronic obstructive pulmonary disease (28% vs. 16%, p = 0.045), carotid disease (5% vs. 18%, p = 0.004), atrial fibrillation or flutter (p = 0.026). Ultrasound-guided access was less frequently used (63% vs. 43%, p = 0.006). Access-related complications were more frequent in patients with small peripheral vessels (34% vs. 19%, p = 0.020). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Thirty-nine patients (32%) had an access-related complication: 20 (51%) had a bleeding complication; 38 (97%) had a vascular complication; and 30 (77%) had a major complication according to the Valve Academic Research Consortium-2 (VARC-2) criteria. No differences were found between the ultrasound-guided and fluoroscopy-guided access groups. Patients with vascular complications were more likely to have a lower body mass index (26.6 vs. 25.1, p = 0.038) and dyslipidaemia (87% vs. 67%, p = 0.021). They also had smaller maximum luminal diameters (6.4 vs 6.9 mm, p = 0.034), increased sheath-to-femoral artery ratio (SFAR) ratios (1.17 vs. 1.06, p = 0.012), lower total iliofemoral calcium volume (p = 0.036) and higher external iliac artery calcium volume (p = 0.023). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">During follow-up, patients with small peripheral vessels had higher mortality rates at 30 days post-TAVI (1% vs. 8%, p = 0.028), but not at one year post-TAVI. Higher 30-day mortality was observed in patients who did not have a vascular complication (12% vs. 0%, p = 0.030); these patients also tended to present higher EuroScore II values (median 10.3 vs. 4.3, p = 0.019). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Conclusions: </strong>Patients with small peripheral vessels are more likely to have access-related complications. Thirty-day mortality in patients with small peripheral vessels is more frequent in patients with higher EuroScore II values. </span></span></p>
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