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open access

Vol 30, No 1 (2023)
Original Article
Submitted: 2020-10-29
Accepted: 2021-05-05
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 Wiewiórka1, Jarosław Trębacz1, Robert Sobczyński2, Maciej Stąpór1, Elżbieta Ostrowska-Kaim1, Janusz Konstanty-Kalandyk2, Robert Musiał3, Andrzej Gackowski4, Krzysztof Malinowski5, Paweł Kleczyński1, Krzysztof Żmudka1, Bogusław Kapelak2, Jacek Legutko1
DOI: 10.5603/CJ.a2021.0053
·
Pubmed: 34031867
·
Cardiol J 2023;30(1):51-58.
Affiliations
  1. Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
  2. Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
  3. Department of Anesthesiology and Intensive Therapy, John Paul II Hospital, Krakow, Poland
  4. Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Coronary Artery Diseases, John Paul II Hospital, Krakow, Poland
  5. 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland

open access

Vol 30, No 1 (2023)
Original articles — Interventional cardiology
Submitted: 2020-10-29
Accepted: 2021-05-05
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 (interquartile range) 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) mL 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) days 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 (interquartile range) 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) mL 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) days 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

Vol 30, No 1 (2023)

Article type

Original Article

Pages

51-58

Published online

2021-05-21

Page views

3621

Article views/downloads

659

DOI

10.5603/CJ.a2021.0053

Pubmed

34031867

Bibliographic record

Cardiol J 2023;30(1):51-58.

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

References (30)
  1. Leon MB, Smith CR, Mack M, et al. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363(17): 1597–1607.
    CrossRefPubMed
  2. Parma R, Zembala MO, Dąbrowski M, et al. Transcatheter aortic valve implantation. Expert Consensus of the Association of Cardiovascular Interventions of the Polish Cardiac Society and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board of the Polish Cardiac Society and National Consultants in Cardiology and Cardiac Surgery. Kardiol Pol. 2017; 75(9): 937–964.
    CrossRefPubMed
  3. Biasco L, Ferrari E, Pedrazzini G, et al. Access sites for TAVI: patient selection criteria, technical aspects, and outcomes. Front Cardiovasc Med. 2018; 5: 88.
    CrossRefPubMed
  4. Hecker F, Arsalan M, Kim W, et al. Transcatheter aortic valve implantation (TAVI) in 2018: recent advances and future development. Minerva Cardioangiol. 2018; 66(3): 314–328.
  5. Dimitriadis Z, Scholtz W, Ensminger SM, et al. Impact of sheath diameter of different sheath types on vascular complications and mortality in transfemoral TAVI approaches using the Proglide closure device. PLoS One. 2017; 12(8): e0183658.
    CrossRefPubMed
  6. Durmuş G, Belen E, Bayyiğit A, et al. Comparison of complication and success rates of proglide closure device in patients undergoing TAVI and endovascular aneurysm repair. Biomed Res Int. 2018; 2018: 2687862.
    CrossRefPubMed
  7. Barbanti M, Capranzano P, Ohno Y, et al. Comparison of suture-based vascular closure devices in transfemoral transcatheter aortic valve implantation. EuroIntervention. 2015; 11(6): 690–697.
    CrossRefPubMed
  8. Biancari F, Romppanen H, Savontaus M, et al. MANTA versus ProGlide vascular closure devices in transfemoral transcatheter aortic valve implantation. Int J Cardiol. 2018; 263: 29–31.
    CrossRefPubMed
  9. Hoffmann P, Al-Ani A, von Lueder T, et al. Access site complications after transfemoral aortic valve implantation: a comparison of Manta and ProGlide. CVIR Endovasc. 2018; 1(1): 20.
    CrossRefPubMed
  10. Barbash IM, Barbanti M, Webb J, et al. Comparison of vascular closure devices for access site closure after transfemoral aortic valve implantation. Eur Heart J. 2015; 36(47): 3370–3379.
    CrossRefPubMed
  11. Moriyama N, Lindström L, Laine M. Propensity-matched comparison of vascular closure devices after transcatheter aortic valve replacement using MANTA versus ProGlide. EuroIntervention. 2019; 14(15): e1558–e1565.
    CrossRefPubMed
  12. Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol. 2012; 60(15): 1438–1454.
  13. Stąpór M, Trębacz J, Wiewiórka Ł, et al. Direct left ventricular wire pacing during transcatheter aortic valve implantation. Kardiol Pol. 2020; 78(9): 882–888.
    CrossRefPubMed
  14. Kleczynski P, Dziewierz A, Socha S, et al. Direct rapid left ventricular wire pacing during balloon aortic valvuloplasty. J Clin Med. 2020; 9(4): 1017.
    CrossRefPubMed
  15. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173(5): 489–495.
    CrossRefPubMed
  16. Walas RL, Kukulski L, Rychter J, et al. Vascular access site complications after transfemoral transcatheter aortic valve implantation in the POL-TAVI Registry: surgical versus percutaneous approach. J Cardiovasc Surg (Torino). 2020; 61(1): 117–122.
    CrossRefPubMed
  17. Wiktorowicz A, Kleczynski P, Dziewierz A, et al. Impact of frailty on mortality after transcatheter aortic valve implantation. Am Heart J. 2017; 185(7): 52–58.
    CrossRefPubMed
  18. Bernardi FLM, Gomes WF, de Brito FS, et al. Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry. Catheter Cardiovasc Interv. 2015; 86(3): 501–505.
    CrossRefPubMed
  19. Karol Z, Grodecki K, Gozdowska R, et al. Use of protamine sulfate during transfemoral transcatheter aortic valve implantation: a preliminary assessment of administration rate and impact on complications. Advances in Interventional Cardiology. 2020; 16(3): 306–314.
    CrossRefPubMed
  20. Kochman J, Kołtowski Ł, Huczek Z, et al. Complete percutaneous approach versus surgical access in transfemoral transcatheter aortic valve implantation: results from a multicentre registry. Kardiol Pol. 2018; 76(1): 202–208.
    CrossRefPubMed
  21. Drafts BC, Choi CH, Sangal K, et al. Comparison of outcomes with surgical cut-down versus percutaneous transfemoral transcatheter aortic valve replacement: TAVR transfemoral access comparisons between surgical cut-down and percutaneous approach. Catheter Cardiovasc Interv. 2018; 91(7): 1354–1362.
    CrossRefPubMed
  22. Généreux P, Webb JG, Svensson LG, et al. PARTNER Trial Investigators. Vascular complications after transcatheter aortic valve replacement: insights from the PARTNER (Placement of AoRTic TraNscathetER Valve) trial. J Am Coll Cardiol. 2012; 60(12): 1043–1052.
    CrossRefPubMed
  23. Tchetche D, de Biase C, Brochado B, et al. How to make the TAVI pathway more efficient. Interv Cardiol. 2019; 14(1): 31–33.
    CrossRefPubMed
  24. van Mourik MS, Geenen LME, Delewi R, et al. Predicting hospitalisation duration after transcatheter aortic valve implantation. Open Heart. 2017; 4(1): e000549.
    CrossRefPubMed
  25. Barbanti M, van Mourik MS, Spence MS, et al. Optimising patient discharge management after transfemoral transcatheter aortic valve implantation: the multicentre European FAST-TAVI trial. EuroIntervention. 2019; 15(2): 147–154.
    CrossRefPubMed
  26. Aldalati O, Keshavarzi F, Kaura A, et al. Factors associated with safe early discharge after transcatheter aortic valve implantation. Cardiol J. 2018; 25(1): 14–23.
    CrossRefPubMed
  27. Mallikethi-Reddy S, Akintoye E, Telila T, et al. Transcatheter aortic valve implantation in the United States: Predictors of early hospital discharge. J Interv Cardiol. 2017; 30(2): 149–155.
    CrossRefPubMed
  28. Kedev S, Zafirovska B, Srbinovska-Kostovska E, et al. Minimalistic approach for transcatheter aortic valve implantation (TAVI): open vascular vs. fully percutaneous approach. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2019; 40(2): 5–14.
    CrossRefPubMed
  29. Giordano A, Corcione N, Ferraro P, et al. Registro Italiano GISE sull'impianto di Valvola Aortica Percutanea (RISPEVA) Study Investigators. Comparison of ProGlide vs. Prostar in patients undergoing transcatheter aortic valve implantation. Minerva Cardioangiol. 2019; 67(6): 443–449.
    CrossRefPubMed
  30. Urbach J, Hou CR, Lesser JR, et al. Computed tomographic angiography-derived risk factors for vascular complications in percutaneous transfemoral transcatheter aortic valve implantation. Am J Cardiol. 2019; 124(1): 98–104.
    CrossRefPubMed

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