Procedural and Clinical Outcomes According to Ultrasound-Guided Access in TAVI: A Propensity-Matched Comparative Subanalysis From the PULSE Registry.

IF 7.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Interventions Pub Date : 2025-05-29 DOI:10.1161/CIRCINTERVENTIONS.124.014771

David Grundmann, Tanja Rudolph, Matti Adam, Caroline Kellner, Sabine Bleiziffer, Daniel Braun, Alexander R Tamm, Max Meertens, Matthias Renker, Jonas Gmeiner, Alexander Sedaghat, David Leistner, Christian W Hamm, Hendrik Wienemann, Norvydas Zapustas, Benjamin Juri, Mostafa Salem, Roman Benetti-Lehmann, Henryk Dreger, Alina Gossling, Awesta Nahif, Stefan Blankenberg, Hermann Reichenspurner, Niklas Schofer, Andreas Schaefer, Jasmin Popara, Misumasa Sudo, Martin Geyer, Marc Vorpahl, Derk Frank, Max Potratz, Won Kim, Moritz Seiffert

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Abstract

Background: Access-related vascular and bleeding complications during transcatheter aortic valve implantation (TAVI) are associated with significant morbidity and mortality. Ultrasound-guided (USG) puncture may reduce the incidence of these adverse events, particularly in large-bore arterial access. However, large-scale data on this approach are limited, and it has not yet been fully implemented into standard clinical practice. We compared access-related vascular and bleeding complications in USG versus fluoroscopy-guided access from a large multicenter TAVI registry.

Methods: The PULSE registry (Plug- or Suture-Based Vascular Closure After TAVI) retrospectively evaluated data of 9295 patients who underwent transfemoral TAVI at 10 high-volume German heart centers (2016-2021). USG and fluoroscopy-guided access were performed in 1992 (21.4%) and 7303 (78.6%) patients, respectively. Propensity score matching (1:1) yielded 895 matched pairs. The primary end point, a composite of minor and major vascular complications or bleeding type II-IV, was assessed according to Valve Academic Research Consortium definitions.

Results: Patients in the USG and fluoroscopy-guided groups (median age, 81.9 [78.3-85.0] years; 47.8% female patients) showed well-balanced baseline characteristics. The overall risk profile was comparable (median EuroSCORE II: 3.2 versus 3.5; SD, 0.007 [-0.086 to 0.099]). The composite primary end point occurred less frequently in the USG group (11.7% versus 16.0%; odds ratio, 0.7; P=0.01), driven by lower rates of procedural bleeding (5.4% versus 9.2%; odds ratio, 0.56; P=0.002) and with lower rates of endovascular treatment (0.7% versus 2.5%; P=0.005).

Conclusions: In patients with transfemoral TAVI, USG access demonstrated lower rates of access-related vascular complications and type II-IV bleeding compared with fluoroscopy-guided access. Implementing USG puncture as the standard of care may improve access-related outcomes after TAVI.

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根据超声引导下TAVI的程序和临床结果：来自PULSE登记的倾向匹配比较亚分析。

背景：经导管主动脉瓣植入术（TAVI）中与通道相关的血管和出血并发症与显著的发病率和死亡率相关。超声引导（USG）穿刺可以减少这些不良事件的发生率，特别是在大口径动脉通路。然而，关于这种方法的大规模数据有限，并且尚未完全实施到标准临床实践中。我们从一个大型多中心TAVI注册表中比较了USG与透视引导下通路相关的血管和出血并发症。方法：在TAVI后，以堵头或缝合线为基础的血管关闭登记回顾性评估了2016-2021年在德国10个大容量心脏中心接受经股动脉TAVI的9295例患者的数据。USG和透视引导下的入路分别为1992例（21.4%）和7303例（78.6%）。倾向分数匹配（1:1）得到895对匹配。主要终点是次要和主要血管并发症或II-IV型出血的综合，根据瓣膜学术研究协会的定义进行评估。结果：USG组和透视组患者(中位年龄81.9[78.3-85.0]岁；47.4%女性)基线特征平衡良好。总体风险状况相当(平均EuroSCORE II: 3.2 vs 3.5；SD, 0.007[-0.086 ~ 0.099])。综合主要终点在USG组发生的频率较低(11.7%比16.0%；优势比，0.7；P=0.01)，这是因为大口径通路相关出血的发生率较低(5.4%比9.2%；优势比0.56；P=0.002)和较低的血管内治疗率(0.7% vs 2.5%；P = 0.005)。结论：在经股TAVI患者中，与透视引导下的通路相比，USG通路显示通路相关血管并发症和II-IV型出血的发生率较低。实施USG穿刺作为TAVI后的标准护理可以改善可及性相关的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

1.80%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.