title: Impact of the use of transradial versus transfemoral approach as secondary access in transcatheter aortic valve implantation procedures.
abstract: No data exist on the impact of vascular complications related to the secondary access site in transcatheter aortic valve implantation (TAVI). The objectives of this nonrandomized study were to determine the rate of vascular complications related to the secondary access site in TAVI procedures and to evaluate the clinical impact of using the radial versus femoral approach as a secondary access in such procedures. A total of 462 consecutive patients (mean age 79 ± 9 years, 50% men) who underwent TAVI were included. The femoral approach (FA) was used as the secondary access (for the insertion of a 5F pigtail catheter) in 335 patients and the radial approach (RA) in 127 patients. Thirty-day events were prospectively collected. There were no baseline differences between groups, except for a higher prevalence of women and peripheral disease in the FA group (p <0.05 for both). A total of 74 vascular access site complications occurred in 70 patients (15%), and 23% of them (29% in the FA group) were related to the secondary access. The use of FA as secondary access was associated with a higher rate of vascular complications (5.0% vs 0% in the RA group, p = 0.005, adjusted p = 0.014). All major vascular complications related to the secondary access occurred in the FA group (3% vs 0% in the RA group, p = 0.040, adjusted p = 0.049), and this translated into a higher rate of major and/or life-threatening bleeding events related to the secondary access in the FA group (3% vs 0% in the RA group, p = 0.040, adjusted p = 0.049). In conclusion, about 1/4 of vascular access site complications in TAVI are related to the secondary access. The use of the RA as a secondary access was associated with a major reduction in vascular complications. These results highlight the impact of secondary access vascular complications in TAVI procedures and support the use of the RA as the preferred secondary access.
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Allende
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Juan G
authors.initials: JG
authors.lastname: Cordoba
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Henrique Barbosa
authors.initials: HB
authors.lastname: Ribeiro
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Amat-Santos
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: DeLarochellière
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Paradis
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Côté
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdul-Jawad
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Del Trigo
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: María Rosario
authors.initials: MR
authors.lastname: Ortas
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Laflamme
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Jerôme
authors.initials: J
authors.lastname: Laflamme
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Hugo
authors.initials: H
authors.lastname: DeLarochellière
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D017534:Radial Artery; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*