Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y |
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Impact of transradial versus transfemoral access for preprocedural coronary angiography on TAVR associated outcomes | ||
B. Al-Kassou1, A. Aksoy1, J. Shamekhi1, A. Zietzer1, M. Weber1, J.-M. Sinning2, F. Jansen1, E. Grube1, F. Bakhtiary3, S. Zimmer1, G. Nickenig1, A. Sedaghat1 | ||
1Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; 2Innere Medizin III - Kardiologie, St. Vinzenz-Hospital, Köln; 3Klinik für Herzchirurgie, Universitätsklinikum Bonn, Bonn; | ||
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is still associated with several procedure-specific complications, that have a significant impact on mortality. Preprocedural coronary angiography is standard practice before TAVR. In patients undergoing percutaneous coronary intervention, transradial artery access (TRA) has been shown to be superior to transfemoral artery access (TFA), which is associated with higher rates of bleeding and vascular complications. However, whether the access-site of preprocedural coronary angiography affects TAVR-related outcomes is not known.
OBJECTIVES: The aim of our study was to evaluate if the selection of the vascular access point for preprocedural coronary angiography is associated with the occurrence of vascular and bleeding complications in patients undergoing subsequent TAVR, and whether this might affect the clinical outcomes.
METHODS: Our study cohort included 1002 patients undergoing transfemoral TAVR, , of whom 39.4% (395/1002) had undergone radial and 60.6% (607/1002) femoral access for pre-TAVR coronary angiography. The primary endpoint was a composite of 30-day all-cause mortality and major vascular complications. Key secondary endpoints included VARC-3-defined complications.
RESULTS: The mean age of our study population was 80.9±6.0 years; 46% were female. Clinical characteristics were well balanced between the two groups. The primary endpoint occurred less frequently in patients with prior TRA (3.3%) as compared to patients with prior TFA (6.3%, p=0.04). This was mainly driven by significantly lower rates of major vascular complications in the TRA group (0.8 vs 2.5%, p=0.05), as presented in Figure 1. Moreover, periprocedural mild to moderate access-related vascular injury and unplanned endovascular interventions were lower in the TRA as compared to the TFA group (13.1 vs 20.4%, p=0.05; 13.2 vs 18.0%, p=0.05, respectively). The rate of major bleedings tended to be lower in the TRA (1.5%) as compared to the TFA group (3.5%) but was not significantly different (p=0.07). Moreover, the rate of life-threatening bleeding was comparable between both groups (0.5% vs 0.8%, p=0.71).
Conclusion: Transradial access for preprocedural coronary angiography was associated with significantly lower rates of vascular complications following subsequent TAVR as compared to transfemoral access. However, despite the tendency to lower major bleedings with transradial access, no significant association was detectable between the access-site of coronary angiography and bleeding complications after TAVR. |
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https://dgk.org/kongress_programme/ht2022/aP707.html |