TY - JOUR
T1 - Procedural and Clinical Outcomes According to Ultrasound-Guided Access in TAVI
T2 - A Propensity-Matched Comparative Subanalysis from the PULSE Registry
AU - Grundmann, David
AU - Rudolph, Tanja
AU - Adam, Matti
AU - Kellner, Caroline
AU - Bleiziffer, Sabine
AU - Braun, Daniel
AU - Tamm, Alexander R.
AU - Meertens, Max
AU - Renker, Matthias
AU - Gmeiner, Jonas
AU - Sedaghat, Alexander
AU - Leistner, David
AU - Hamm, Christian W.
AU - Wienemann, Hendrik
AU - Zapustas, Norvydas
AU - Juri, Benjamin
AU - Salem, Mostafa
AU - Benetti-Lehmann, Roman
AU - Dreger, Henryk
AU - Gossling, Alina
AU - Nahif, Awesta
AU - Blankenberg, Stefan
AU - Reichenspurner, Hermann
AU - Schofer, Niklas
AU - Schaefer, Andreas
AU - Popara, Jasmin
AU - Sudo, Misumasa
AU - Geyer, Martin
AU - Vorpahl, Marc
AU - Frank, Derk
AU - Potratz, Max
AU - Kim, Won
AU - Seiffert, Moritz
N1 - Publisher Copyright:
© 2025 American Heart Association, Inc.
PY - 2025/8/1
Y1 - 2025/8/1
N2 - 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.
AB - 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.
KW - fluoroscopy
KW - hemorrhage
KW - morbidity
KW - punctures
KW - registries
KW - retrospective studies
KW - standard of care
UR - https://www.scopus.com/pages/publications/105007069464
U2 - 10.1161/CIRCINTERVENTIONS.124.014771
DO - 10.1161/CIRCINTERVENTIONS.124.014771
M3 - Article
C2 - 40438925
AN - SCOPUS:105007069464
SN - 1941-7640
VL - 18
SP - e014771
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 8
ER -