Author + information
- Received December 16, 2019
- Revision received February 25, 2020
- Accepted March 31, 2020
- Published online June 15, 2020.
- Guy Witberg, MDa,b,c,∗ (, )@GuyWitberg,
- Vasileios Tzalamouras, MDc,d,
- Heath Adams, BMedSci, MBBSa,
- Tiffany Patterson, MD, PhDa,
- Ross Roberts-Thomson, MBBSa,
- Jonathan Byrne, MD, PhDd,
- Rafal Dworakowski, MD, PhDd,
- Philip MacCarthy, MD, PhDd,
- Simon Redwood, MBBS, MDa and
- Bernard Prendergast, BM, BS, DMa
- aDepartment of Cardiology, St Thomas' Hospital, London, United Kingdom
- bDepartment of Cardiology, Rabin Medical Center, Petach Tikva, Israel
- cSackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- dDepartment of Cardiology, King's College Hospital, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Guy Witberg, Department of Cardiology, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva, NA 49100, Israel.
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.
Dr. Redwood has received speaker fees from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received December 16, 2019.
- Revision received February 25, 2020.
- Accepted March 31, 2020.
- 2020 American College of Cardiology Foundation
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