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Published online: 2021-05-21
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Computed tomography guided tailored approach to transfemoral access in patients undergoing transcatheter aortic valve implantation

Łukasz Wiewiórka, Jarosław Trębacz, Robert Sobczyński, Maciej Stąpór, Elżbieta Ostrowska-Kaim, Janusz Konstanty-Kalandyk, Robert Musiał, Andrzej Gackowski, Krzysztof Malinowski, Paweł Kleczyński, Krzysztof Żmudka, Bogusław Kapelak, Jacek Legutko
DOI: 10.5603/CJ.a2021.0053
·
Pubmed: 34031867

open access

Ahead of print
Original articles
Published online: 2021-05-21

Abstract

Background: Transfemoral approach (TFA) is the most common access route for transcatheter aortic valve implantation (TAVI). Percutaneous femoral access (PA) is preferred over the surgical approach (SA), however, may be associated with a higher risk of access site complications. Thus, we aimed to assess outcomes of computed tomography-guided tailored approach to percutaneous and surgical TFA in patients undergoing TAVI.

Methods: We evaluated data of 158 patients, who underwent TAVI via femoral route between January 2017 and December 2018. In the PA group, vascular closure was performed with the use of two percutaneous suture devices and an additional mechanical seal device. We compared complications rate and outcomes.

Results: Of the 158 patients (92%; mean age 79.6 years, 60.8% female), in 92 (61%) patients PA was performed and in 66 (39%) patients SA was used. Median (IQR) radiation exposure as well as contrast volume dose was higher in the PA group compared to the SA group 614.0 (410.0; 1104.0) mGy vs. 405 (240.5; 658.0) mGy (p < 0.001) and 150.0 (120.0; 180.7) vs. 130.0 (100.0; 160.0) mL, (p = 0.04), respectively. Bleeding complications were similar in the PA group 11 (12.2%) compared to 5 (8.62%) in the SA group (p = 0.48). Median length of hospital stay was also similar in the PA and the SA group 6.00 (5.00; 8.00) vs 6.00 (4.00; 8.00) days, respectively, p = 0.31).

Conclusions: Computed tomography-guided PA in TAVI may provide comparable procedural outcomes compared to the SA, despite a higher radiation dose and the use of contrast dye, while being less invasive.

Abstract

Background: Transfemoral approach (TFA) is the most common access route for transcatheter aortic valve implantation (TAVI). Percutaneous femoral access (PA) is preferred over the surgical approach (SA), however, may be associated with a higher risk of access site complications. Thus, we aimed to assess outcomes of computed tomography-guided tailored approach to percutaneous and surgical TFA in patients undergoing TAVI.

Methods: We evaluated data of 158 patients, who underwent TAVI via femoral route between January 2017 and December 2018. In the PA group, vascular closure was performed with the use of two percutaneous suture devices and an additional mechanical seal device. We compared complications rate and outcomes.

Results: Of the 158 patients (92%; mean age 79.6 years, 60.8% female), in 92 (61%) patients PA was performed and in 66 (39%) patients SA was used. Median (IQR) radiation exposure as well as contrast volume dose was higher in the PA group compared to the SA group 614.0 (410.0; 1104.0) mGy vs. 405 (240.5; 658.0) mGy (p < 0.001) and 150.0 (120.0; 180.7) vs. 130.0 (100.0; 160.0) mL, (p = 0.04), respectively. Bleeding complications were similar in the PA group 11 (12.2%) compared to 5 (8.62%) in the SA group (p = 0.48). Median length of hospital stay was also similar in the PA and the SA group 6.00 (5.00; 8.00) vs 6.00 (4.00; 8.00) days, respectively, p = 0.31).

Conclusions: Computed tomography-guided PA in TAVI may provide comparable procedural outcomes compared to the SA, despite a higher radiation dose and the use of contrast dye, while being less invasive.

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Keywords

aortic stenosis, outcomes, transcatheter aortic valve implantation, vascular access, vascular closure devices

About this article
Title

Computed tomography guided tailored approach to transfemoral access in patients undergoing transcatheter aortic valve implantation

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-05-21

DOI

10.5603/CJ.a2021.0053

Pubmed

34031867

Keywords

aortic stenosis
outcomes
transcatheter aortic valve implantation
vascular access
vascular closure devices

Authors

Łukasz Wiewiórka
Jarosław Trębacz
Robert Sobczyński
Maciej Stąpór
Elżbieta Ostrowska-Kaim
Janusz Konstanty-Kalandyk
Robert Musiał
Andrzej Gackowski
Krzysztof Malinowski
Paweł Kleczyński
Krzysztof Żmudka
Bogusław Kapelak
Jacek Legutko

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