SPC365

Clinical Insights: Ultrasound-Guided Femoral Puncture in Transcatheter Aortic Valve Replacement - A Comprehensive Analysis of Vascular Complications and Mortality Rates

Session: Sessão de Posters 47 - TAVI
Speaker: Marta Miguez Vilela

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: Marta Miguez De Freitas Vilela; Catarina Simões de Oliveira; Ana Margarida Martins; Ana Beatriz Garcia; Ana Abrantes; Catarina Gregório; Miguel Nobre Menezes; João Silva Marques; Cláudia Jorge; Pedro Carrilho Ferreira; Pedro Cardoso; Fausto J. Pinto

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong>: </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Arterial femoral access is the most commonly utilized access point for transcatheter aortic valve replacement (TAVR) and is recognized for its association with bleeding and vascular complications. Precise placement of the femoral sheath is crucial to avoid complications, making ultrasound (US)-guided puncture an indispensable tool.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective</strong>: </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To compare the incidence of vascular complications between US-guided and non-US-guided femoral punctures.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong>: </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A single-center study was conducted on consecutive patients (pts) undergoing transfemoral TAVR. Vascular complications were documented and further classified as minor (small dissection without flow compromise and small subcutaneous hematoma) and major complications. A comparative analysis between US-guided and non US-guided punctures and 30-day mortality rates were reported. Descriptive and comparative statistical analyses were employed.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong>: </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 601 pts underwent transfemoral TAVR, with 54% being female (mean age of 82 years). The main co-morbidities included arterial hypertension (91.9%), dyslipidemia (76.3%), diabetes (37.4%), and chronic kidney disease (CKD, 29.6%). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In 17.5% of TAVR, femoral artery puncture was US-guided. Major vascular complications (91 cases) and minor complications (50 cases) were observed &ndash; graphic 1. US-guided puncture was associated with fewer vascular complications (p&lt;0.001), including major complications (p=0.017), and was also linked to fewer blood transfusion (p=0.018). Among patient co-morbidities, CKD was associated with vascular complications (p=0.020), and renal function replacement therapy was linked to major complications (p=0.048). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The main closures devices used were Perclose and MANTA, with the last associated with a lower incidence of vascular complications (p=0.035). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">CKD and US-guided puncture emerged as independent predictors of vascular complications, with CKD posing a 1.6x increased risk (OR=1.57, CI 1-2.4) and US-guided puncture indicating a 3x decreased risk (OR=3, CI 1.3-7.7). Vascular complications were correlated with both in-hospital and 30-day mortality (p=0.005).</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p><strong><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Conclusion</span></span></strong><span style="font-size:12pt"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">: </span></span></span></p>

<p><span style="font-size:12pt"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">US-guided femoral puncture independently predicts a lower incidence of vascular complications, which, in turn, are associated with higher in-hospital and 30-day mortality rates. This evidence supports the recommendation that US-guided puncture should be considered the standard of care for patients undergoing TAVR.</span></span></span></p>