Key result
Percutaneous femoral access for TAVI had similar bleeding complications compared to the surgical approach (12.2% vs 8.62%; P=0.48), despite higher radiation and contrast doses.
Why the study?
Percutaneous femoral access is preferred over surgical access for TAVI but may carry a higher risk of access site complications.
Does computed tomography-guided percutaneous femoral access provide comparable procedural outcomes to a surgical approach in patients undergoing TAVI?
Cohort (n=158)
Does computed tomography-guided percutaneous femoral access provide comparable procedural outcomes to a surgical approach in patients undergoing TAVI?
Absolute Event Rate: 12.2% vs 8.62%
p-value: p=0.48
CT-guided percutaneous femoral access for TAVI yields comparable bleeding complications and hospital stay to surgical access, though it requires more radiation and contrast.
May support CT-guided individualized TFA choice in TAVI; leaves open prospective validation before practice change.
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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Wiewiórka et al. (2021) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=158). Percutaneous femoral access vs. Surgical approach was evaluated on Bleeding complications (p=0.48). Percutaneous femoral access for TAVI had similar bleeding complications compared to the surgical approach (12.2% vs 8.62%; P=0.48), despite higher radiation and contrast doses.
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