Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea

Abstract

Introduction and Objectives: Transcatheter aortic valve implantation (TAVI) is an increasingly used technique. The use of ultrasound guidance for femoral artery puncture can reduce vascular and bleeding access-related complications. The objectives of this study were: 1) to evaluate the impact of echo-guided access on TAVI-related vascular and bleeding complications and 30-day mortality and 2) to identify the predictors of these outcomes. Methods: Patients who underwent transfemoral TAVI between January and December 2017 (fluoroscope-guided access) and between June 2018 and May 2019 (echo-guided access) were included (n=230). The occurrence of vascular and bleeding complications, 30-day mortality and the composite endpoints of 1) any vascular or bleeding complications; and 2) any vascular or bleeding complications or the need for transfusion of ≥2 units of red blood cells (URBC) between the two groups were compared. Results: Haemorrhage (24,3% vs 9,4%, p=0,003), vascular complications (27,7% vs 16,9%, p=0,05) and 30-day mortality (13,9% vs 1,8%, p=0,001) were more common in the fluoroscopy-guided group. In multivariable regression, the use of echo-guided access was an independent predictor of less haemorrhage (OR=0,408, IC95% 0,170-0,82, p=0,045) and the composite of any vascular or bleeding complication or the need for transfusion of ≥2 URBC (OR=0,509, IC95% 0,264-0,979, p=0,043). A BMI greater than 26,64 kg/m2 was protective against vascular complications (11,6% vs 36,4%, p<0,001). Concerning 30-day mortality, echo-guided access did not remain a predictor after adjusting for EuroSCORE II. Conclusion: Echo-guided accesses reduced TAVI-related vascular and bleeding complications and 30-day mortality. BMI was associated with fewer vascular complications, highlighting the obesity paradox associated with TAVI procedures.