P1847Comparing outcomes and complications between transfemoral TAVI performed with or without echoguided puncture

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: Bouteau, J, Bourguignon, T, Caze, C, Quilliet, L, Ivanes, F, Desveaux, B, Clerc, J M, Saint Etienne, C
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-10-2019
• Subjects: Aortic Valve Intervention
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz748.0598

Abstract
Objective
Transcatheter Aortic Valve Replacement (TAVI) has become the reference procedure in intermediate or high surgical risk patients with degenerative aortic stenosis. Vascular complications are associated with poorer outcomes in patients after TAVI. Transfemoral (TF) echoguided puncture (EGP) became a routine procedure in our center in May 2017. We conducted a retrospective analysis to compare outcomes between patients whose TAVI was performed with or without routine EGP in our population.
Methods
We included all patients with TF TAVI performed in our center between January 2016 and December 2018. Since May 2017, all TF TAVI were performed using TF EGP for the main access and transradial puncture for the secondary access. Patient population was divided into two historical groups: fluoroscopic guided puncture (FGP) and EGP. Patients whose TAVI were performed in May 2017 were excluded due to operators learning curve. Post procedure mortality and vascular complications were retrospectively extracted from our institution data system.
Results
Among the 611 TAVI performed between January 2016 and December 2018, 28 did not have TF access. Twelve patients with procedure in May 2017 (learning curve) were excluded. Thus, 573 patients were analyzed. Age was not significantly different between FGP and EGP groups (84.9±5,7 vs. 83.8±6.6 years, p=0.051). No significant differences in in-hospital and 1 month mortality were observed between FGP and EGP groups (1.9 vs. 1.5%, p=0.74 and 3.2 vs. 1.8%, p=0.26). Minor vascular complications were not significantly different between groups (12.5 vs. 12.3%, p=1) but major vascular complications were significantly less frequent in EGP (5.6 vs. 10.2%, p=0.046). After introducing EGP, surgical TF access were also less frequently needed (2.8 vs. 0.3%, p=0.02).
Conclusion
Our single center retrospective study suggests that using TF EGP to perform TAVI is safe and may reduce both the rate of major vascular complication and the need for surgical TF access.
Acknowledgement/Funding
None