Comparison of ultrasound- versus fluoroscopy-guidEd femorAl access In tranS-catheter aortic valve replacement In the Era of contempoRary devices: The EASIER registry

• Published in: Cardiovascular revascularization medicine 2024-05, Vol.62, p.40-47
• Main Authors: Bianchini, Emiliano, Morello, Alberto, Bellamoli, Michele, Romagnoli, Enrico, Aurigemma, Cristina, Tagliaferri, Marco, Montonati, Carolina, Dumonteil, Nicolas, Cimmino, Michele, Villa, Emmanuel, Corcione, Nicola, Bettari, Luca, Messina, Antonio, Stanzione, Alessio, Troise, Giovanni, Mor, Donata, Maggi, Antonio, Bellosta, Raffaello, Pegorer, Matteo Alberto, Zoccai, Giuseppe Biondi, Ielasi, Alfonso, Burzotta, Francesco, Trani, Carlo, Maffeo, Diego, Tchétché, Didier, Buono, Andrea, Giordano, Arturo
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Catheterization, Peripheral - adverse effects; Catheterization, Peripheral - instrumentation; Female; Femoral Artery - diagnostic imaging; Fluoroscopy; Heart Valve Prosthesis; Humans; Male; Prospective Studies; Prosthesis Design; Punctures; Radiography, Interventional - adverse effects; Registries; Risk Factors; Time Factors; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Treatment Outcome; Ultrasonography, Interventional
• ISSN: 1553-8389; 1878-0938; 1878-0938
• DOI: 10.1016/j.carrev.2023.12.007

Vascular complications (VCs) still represent one of the principal concerns of trans-femoral trans-catheter aortic valve replacement (TF-TAVR). New-generation devices can minimize such complications but the arterial access management is left to the operator's choice. This study aims to describe the rate of VCs in a contemporary cohort of patients undergoing TAVR with new-generation devices and to determine whether an ultrasound-guided (USG) vs. a fluoroscopy-guided (FG) femoral access management has an impact on their prevention. This is a prospective, observational, multicenter study. Consecutive patients undergoing TAVR with new-generation devices were analyzed from January 2022 to October 2022 in five tertiary care centers. Femoral accesses were managed according to the operator's preferences. All the patients underwent a pre-discharge peripheral ultrasound control. VCs and bleedings were the main endpoints of interest. A total of 458 consecutive patients were enrolled (274 in the USG group and 184 in the FG group). VCs occurred in 6.5 % of the patients (5.2 % minor and 1.3 % major). There was no difference between the USG and the FG groups in terms of any VCs (7.3 % vs. 5.4 %; p = 0.4), or any VARC-3 bleedings (6.9 % vs 6 %, p = 0.9). At logistic regression analysis, the two guidance strategies did not result as predictors of VCs (odds Ratio 0.8, 95 % Confidence Interval 0.46-1.4; P = 0.4). In a contemporary cohort of patients undergoing TAVR with new-generation devices, the occurrence of VCs is low and mostly represented by minor VCs. USG and FG modalities did not affect the rate of VCs.