Routine Ultrasound or Fluoroscopy Use and Risk of Vascular Bleeding/Complications After Transfemoral TAVR

Guy Witberg, Vasileios Tzalamouras, Heath Adams, Tiffany Patterson, Ross Roberts-Thomson, Jonathan Byrne, Rafal Dworakowski, Philip MacCarthy, Simon Redwood, Bernard Prendergast

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: This study aimed to examine the benefits of routine use of 2D-US in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). Background: Two-dimensional ultrasound (2D-US) reduces access-related vascular complications (VCs) and bleeding in patients undergoing percutaneous coronary intervention via transfemoral approach. Potential similar benefits in patients undergoing transfemoral TAVR have not been systemically investigated. Methods: Rates of access-related VCs or bleeding were compared using 5-year retrospective observational data from 2 neighboring high-volume UK TAVR centers systemically using 2 different techniques (center 1: fluoroscopy and contralateral angiography [FCA], center 2: 2D-US) for femoral puncture at the time of transfemoral TAVR. Results: Overall, 1,171 patients were included in the study (FCA, n = 624; 2D-US, n = 529). Baseline clinical and procedural characteristics were similar between the 2 groups. There was no difference in the risk of VCs, bleeding, or their composite according to femoral puncture technique (FCA vs. 2D-US: 6.7% [95% confidence interval (CI): 4.9% to 8.9%] vs. 6.8% [95% CI: 4.8% to 9.3%]; p = 0.63; 6.1% [95% CI: 4.4% to 8.2%] vs. 6.4% [95% CI: 4.8% to 9.3%]; p = 0.70; and 9.8% [95% CI: 7.6% to 12.4%] vs. 9.8% [95% CI: 7.4% to 12.7%]; p = 0.76, respectively) and no difference when analysis was restricted to a composite of major VCs or major and life-threatening bleeding. Conclusions: Vascular and bleeding complications can be achieved using either FCA or 2D-US guidance. Further studies are required to identify and assess alternative strategies to reduce periprocedural VCs and bleeding in this patient population.

Original languageEnglish
Pages (from-to)1460-1468
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume13
Issue number12
DOIs
StatePublished - 22 Jun 2020

Keywords

  • 2-dimensional ultrasound
  • arterial access
  • bleeding
  • TAVR
  • vascular complications

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