Key result
The systematic use of the LITE-TAVI technique resulted in a 30-day mortality of 1.7%, which was significantly lower than the expected mortality of 6.1% predicted by EuroSCORE II (p<0.001).
Why the study?
Although various technical strategies exist to conduct TF-TAVI, the optimal technique is not recognized.
Does the less-invasive totally-endovascular (LITE) technique improve the safety profile and reduce access-related complications in patients undergoing transfemoral TAVI?
Observational (n=1,022)
No
Does the less-invasive totally-endovascular (LITE) technique improve the safety profile and reduce access-related complications in patients undergoing transfemoral TAVI?
Absolute Event Rate: 1.7% vs 6.1%
p-value: p=<0.001
A less-invasive totally endovascular (LITE) approach to trans-femoral TAVI—avoiding routine ancillary femoral and central venous accesses—is highly feasible and yields extremely low rates of vascular complications and bleeding.
LITE-TAVI was associated with lower-than-predicted 30-day mortality in this cohort; leaves open whether randomized trials confirm safety gains over standard approaches.
Background: Trans-femoral (TF) represents the main access for TAVI. Although there are various technical strategies to conduct TF-TAVI (pacing modality, secondary arterial access, primary access puncture etc.), the optimal technique is not recognized. Aims: In the present study, we assessed the impact of systematic use of LITE-TAVI in terms of feasibility, safety, and main access complication management using VARC-3 outcomes definitions. Methods: At our institution, a less-invasive totally-endovascular (LITE) technique for TF-TAVI has been developed since 2017. Key aspects are: precise TAVI access puncture using angiographic-guidewire ultrasound guidance; radial/ulnar approach as the default "secondary access"; non-invasive pacing (by guidewire stimulation or definitive pacemaker external programmer). Results: 1022 consecutive TF-TAVI patients (55 % women, mean age: 80 years, mean EuroSCORE II 6.1 %, mean STS-PROM 4.3 %, mean STS/ACC TVT TAVR mortality score 3.4 %) were approached using the LITE technique. Technical success was achieved in 993 (97.2 %) patients. Access-related major vascular complications occurred in 12 (1.2 %) and VARC-3 ≥ type 2 bleedings in 12 (1.2 %) patients. At 30-day, all-cause death occurred in 17 (1.7 %) patients. This figure resulted significantly lower than expected on the bases of the mortality predicted not only by EuroSCORE II (6.1 %, p < 0.001) and STS-PROM score (4.3 %; p < 0.001), but also by STS/ACC TVT TAVR mortality score (3.4 %; p = 0.01). Conclusions: Systematic use of LITE-TAVI is feasible and is associated with an extremely low rate of access-related bleeding and vascular complications which may drive to outcome improvement.
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Romagnoli et al. (2024) conducted an observational in Severe aortic valve disease (n=1,022). Less-invasive totally-endovascular (LITE) TAVI technique vs. Predicted surgical mortality (EuroSCORE II and STS-PROM) was evaluated on 30-day all-cause death (compared to expected EuroSCORE II mortality) (p=<0.001). The systematic use of the LITE-TAVI technique resulted in a 30-day mortality of 1.7%, which was significantly lower than the expected mortality of 6.1% predicted by EuroSCORE II (p<0.001).
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