Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience

• Published in: International journal of cardiology. Heart & vasculature 2024-12, Vol.55, p.101523, Article 101523
• Main Authors: Romagnoli, Enrico, Bianchini, Francesco, Aurigemma, Cristina, Zito, Andrea, Bianchini, Emiliano, Paraggio, Lazzaro, Lunardi, Mattia, Ierardi, Carolina, Nesta, Marialisa, Bruno, Piergiorgio, Burzotta, Francesco, Trani, Carlo
• Format: Article
• Language: English
• Subjects: Original Paper; Personalized medicine, endovascular interventions; Temporary pacemaker; Trans-femoral approach; Trans-radial approach; Transcatheter aortic valve implantation
• ISSN: 2352-9067; 2352-9067
• DOI: 10.1016/j.ijcha.2024.101523

The LITE technique for TF-TAVI. Abbreviations. TF = trans-femoral; TAVI = transcatheter aortic valve implantation; LITE = Less-Invasive Totally-Endovascular; AGU = Angio-Guided-Ultrasound; VC = Vascular Complications. [Display omitted] 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. 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. 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). 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