Alexandru Achim1, Tamás Szűcsborus2, Viktor Sasi2, Ferenc Nagy2, Zoltán Jambrik2, Attila Nemes2, Albert Varga2, Olivier F Bertrand3, Zoltán Ruzsa4. 1. 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary; Medicala 1 Invasive Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania. 2. 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary. 3. Quebec Heart-Lung Institute, University Laval, Quebec, Canada. 4. 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary. Electronic address: ruzsa.zoltan@med.u-szeged.hu.
Abstract
BACKGROUND: Although not yet recommended by the guidelines, distal radial access, a new site for cardiovascular interventions, has been rapidly acknowledged and adopted by many centers due to its high rate of success, safety and fewer complications. We present our experience using secondary distal radial access during transcatheter aortic valve implantation (TAVI), proposing a new, even more minimal approach. METHODS: As of November 2020, a systematic distal radial approach as secondary access site for TAVI was adopted in our center. Primary endpoints were technical success and major adverse events (MAEs). Secondary endpoints: the access site complication rate, hemodynamic and clinical results of the intervention, procedural related factors, crossover rate to the femoral access site, and hospitalization duration (in days). RESULTS: From November 2020, 41 patients underwent TAVI using this strategy. Patients had a mean age of 76 ± 11.2 years, 41% were male. Six (14.63%) patients received a balloon-expandable valve and 35 (85.37%) received a self-expandable valve. TAVI was successful in all cases. No complications occurred due to transradial access. Puncture success, defined as completed sheath placement was maximum (N = 41/41,100%) and emergent transfemoral secondary access was not required in any case. Primary transfemoral vascular access site complications occurred in 7 cases (17%) of which 4 (13.63%) were resolved through distal radial access: one occlusion, two flow-limiting stenoses and four perforations of the common femoral artery. There were no additional major vascular complications at 30 days. Overall MACE rate was 2.4%. CONCLUSION: The use of the distal radial approach for secondary access in TAVI is safe, feasible and has several advantages over old access sites.
BACKGROUND: Although not yet recommended by the guidelines, distal radial access, a new site for cardiovascular interventions, has been rapidly acknowledged and adopted by many centers due to its high rate of success, safety and fewer complications. We present our experience using secondary distal radial access during transcatheter aortic valve implantation (TAVI), proposing a new, even more minimal approach. METHODS: As of November 2020, a systematic distal radial approach as secondary access site for TAVI was adopted in our center. Primary endpoints were technical success and major adverse events (MAEs). Secondary endpoints: the access site complication rate, hemodynamic and clinical results of the intervention, procedural related factors, crossover rate to the femoral access site, and hospitalization duration (in days). RESULTS: From November 2020, 41 patients underwent TAVI using this strategy. Patients had a mean age of 76 ± 11.2 years, 41% were male. Six (14.63%) patients received a balloon-expandable valve and 35 (85.37%) received a self-expandable valve. TAVI was successful in all cases. No complications occurred due to transradial access. Puncture success, defined as completed sheath placement was maximum (N = 41/41,100%) and emergent transfemoral secondary access was not required in any case. Primary transfemoral vascular access site complications occurred in 7 cases (17%) of which 4 (13.63%) were resolved through distal radial access: one occlusion, two flow-limiting stenoses and four perforations of the common femoral artery. There were no additional major vascular complications at 30 days. Overall MACE rate was 2.4%. CONCLUSION: The use of the distal radial approach for secondary access in TAVI is safe, feasible and has several advantages over old access sites.
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Authors: Alexandru Achim; Tímea Szigethy; Dorottya Olajos; Levente Molnár; Roland Papp; György Bárczi; Kornél Kákonyi; István F Édes; Dávid Becker; Béla Merkely; Jef Van den Eynde; Zoltán Ruzsa Journal: Front Cardiovasc Med Date: 2022-05-09
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Authors: Alexandru Achim; Kornél Kákonyi; Zoltán Jambrik; Ferenc Nagy; Julia Tóth; Viktor Sasi; Péter Hausinger; Attila Nemes; Albert Varga; Olivier F Bertrand; Zoltán Ruzsa Journal: J Clin Med Date: 2021-12-20 Impact factor: 4.241