Gabby Elbaz-Greener1, Nevena Zivkovic1, Yaron Arbel2, Sam Radhakrishnan1, Stephen E Fremes1, Harindra C Wijeysundera3. 1. Division of Cardiology and Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada. 2. Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel; affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Division of Cardiology and Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada. Electronic address: harindra.wijeysundera@sunnybrook.ca.
Abstract
BACKGROUND: Major vascular complications have been associated with increased mortality and morbidity in patients undergoing transcatheter aortic valve replacement (TAVR). Our objective was to compare vascular and bleeding outcomes with the routine use of 2-dimensional ultrasonography (2D-US) guided femoral artery access in percutaneous transfemoral TAVR compared with traditional anatomic landmark palpation with angiographically-guided access. METHODS: This single-centre retrospective cohort study was conducted in Ontario, Canada. We enrolled patients from January 1, 2012-June 30, 2016. Routine 2D-US was used in all transfemoral TAVR after January 1, 2014; before this, all cases were performed with angiographic guidance alone. RESULTS: The primary outcome of interest was the composite of any access-related red blood cell transfusion or vascular/bleeding complications. Definitions were based on the Valve Academic Research Consortium (VARC-2) criteria. Fully adjusted multivariable regression models were developed to determine the impact of 2D-US. The study cohort included 387 patients, 109 (28%) of whom underwent femoral artery puncture guided by anatomic and angiographic landmarks, whereas 278 (72%) patients had 2D-US guidance. After adjusting for baseline differences in our multivariable models, we found that 2D-US-guided access was associated with an odds ratio of 0.42 (95% confidence interval, 0.25-0.70; P < 0.01) for the composite end point of access-related vascular or bleeding complications and red blood cell transfusion. CONCLUSIONS: The routine use of 2D-US in transfemoral TAVR was associated with substantial reductions in access-related vascular and bleeding complications.
BACKGROUND: Major vascular complications have been associated with increased mortality and morbidity in patients undergoing transcatheter aortic valve replacement (TAVR). Our objective was to compare vascular and bleeding outcomes with the routine use of 2-dimensional ultrasonography (2D-US) guided femoral artery access in percutaneous transfemoral TAVR compared with traditional anatomic landmark palpation with angiographically-guided access. METHODS: This single-centre retrospective cohort study was conducted in Ontario, Canada. We enrolled patients from January 1, 2012-June 30, 2016. Routine 2D-US was used in all transfemoral TAVR after January 1, 2014; before this, all cases were performed with angiographic guidance alone. RESULTS: The primary outcome of interest was the composite of any access-related red blood cell transfusion or vascular/bleeding complications. Definitions were based on the Valve Academic Research Consortium (VARC-2) criteria. Fully adjusted multivariable regression models were developed to determine the impact of 2D-US. The study cohort included 387 patients, 109 (28%) of whom underwent femoral artery puncture guided by anatomic and angiographic landmarks, whereas 278 (72%) patients had 2D-US guidance. After adjusting for baseline differences in our multivariable models, we found that 2D-US-guided access was associated with an odds ratio of 0.42 (95% confidence interval, 0.25-0.70; P < 0.01) for the composite end point of access-related vascular or bleeding complications and red blood cell transfusion. CONCLUSIONS: The routine use of 2D-US in transfemoral TAVR was associated with substantial reductions in access-related vascular and bleeding complications.
Authors: Roberto Scarsini; Giovanni L De Maria; Jubin Joseph; Lampson Fan; Thomas J Cahill; Rafail A Kotronias; Francesco Burzotta; James D Newton; Rajesh Kharbanda; Bernard Prendergast; Flavio Ribichini; Adrian P Banning Journal: J Am Heart Assoc Date: 2019-09-14 Impact factor: 5.501