November 19, 2019Catheterization and Cardiovascular Interventions
Ultrasound guided vascular access site management and left ventricular pacing are associated with improved outcomes in contemporary transcatheter aortic valve replacement: Insights from the OxTAVI registry
Key result
Ultrasound-guided vascular access management during TAVR was associated with a reduced risk of the composite primary endpoint (OR 0.35; 95% CI 0.14-0.86; p=0.02).
Why the study?
Vascular complications, major bleeding, or pericardial tamponade during TAVR may be influenced by procedural practice, prompting identification of clinical and procedural predictors of avoidable complications.
Do ultrasound-guided vascular access and rapid pacing via the left ventricle guidewire reduce procedural complications in patients undergoing transfemoral TAVR?
Comparison
Predictors including ultrasound-guided access and left ventricular guidewire pacing
Design
Retrospective analysis of a prospective registry
Follow-up
In-hospital
Authors
Discussion
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Implication
May inform TAVR procedural optimization to reduce avoidable complications; hypothesis-generating and requires prospective validation.
Study Design
Type
Observational (n=529)
Structured PICO
Do ultrasound-guided vascular access and rapid pacing via the left ventricle guidewire reduce procedural complications in patients undergoing transfemoral TAVR?
P
Population
529 patients undergoing transfemoral transcatheter aortic valve replacement between January 2015 and September 2018.
E
Exposure
Ultrasound (US) guidance for vascular access management and rapid pacing via the left ventricle guidewire (LV-GW)
C
Comparator
Standard procedural techniques without ultrasound guidance or LV-GW rapid pacing
O
Outcome
Hierarchic composite of in-hospital mortality, pericardial effusion/cardiac tamponade, major bleeding, and vascular access complicationscomposite
Main Result
Odds Ratio: 0.35 (95% CI 0.14–0.86)
p-value: p=0.02
The use of ultrasound-guided vascular access and rapid pacing via the left ventricular guidewire are associated with significant reductions in procedural complications during transfemoral TAVR.
Cite This Study
Kotronias et al. (2019) conducted an observational in Aortic stenosis undergoing transcatheter aortic valve replacement (n=529). Ultrasound-guided vascular access management vs. Without ultrasound guidance was evaluated on Hierarchic composite of in-hospital mortality, pericardial effusion/cardiac tamponade, major bleeding, and vascular access complications (OR 0.35, 95% CI 0.14-0.86, p=0.02). Ultrasound-guided vascular access management during TAVR was associated with a reduced risk of the composite primary endpoint (OR 0.35; 95% CI 0.14-0.86; p=0.02).