Point-of-care Ultrasound guidance to reduce vascular access complications in transfemoral TAVR - 07/06/19
Résumé |
Introduction |
Major vascular (VAC) and life-threatening or major bleeding (LT/MB) complications represent the most frequent adverse outcomes of percutaneous transfemoral TAVR (TF-TAVR). Point-of-Care Ultrasound (POCUS) guidance allows the opportunity to obtain in real-time valuable anatomic informations to puncture in the ideal non-calcified central and horizontal segment of femoral artery. We sought to evaluate in our study the impact of implementation of POCUS-guidance on the vascular and bleeding complications.
Method |
POCUS-guidance for vascular access was implemented as the default approach in our institution in 06/2013 for all TF-TAVR and was applied by all operators after a short training course. Thus, we defined three period and groups of consecutive patients according to the method of puncture (fluoroscopic or POCUS-guidance) and the generation of THV (2nd or 3rd gen.). TF-TAVR with POCUS-guidance and 2nd generation THV and from 06/2013 to 11/2014 (POCUS-guided-2nd gen. group; n=119) were 1:1 successfully matched with 95 patients of the Fluo-guided-2nd gen. with propensity-score (10 variables) (The last TF-TAVR with guidance with 2nd gen. THV; n=119). TF-TAVR implanted with 3rd gen. THV from 11/2014 to 12/2018 (POCUS-guided-3rd gen. group; n=308) were analyzed separately.
Results |
After propensity-matching, all the vascular and bleeding complications were reduced in the POCUS-guided-2nd gen. group compared to Fluo-guided-2nd gen. group with respectively: VAC (6,3% vs. 16,8%; OR=0,31; 95% CI=0,12–0,85; P=0,023); LT/MB (22,1% vs. 6,3%; OR=0.24, CI=0.09-0.63; P=0,004); and VAC related to vascular access (12,6 vs. 4,2%; OR=0,31; CI=0.10–1.01; P=0,052).
Conclusion |
This is the first and the largest study to demonstrate that POCUS-guided cannulation of the femoral artery is associated with a reduction of vascular and bleeding complication and support POCUS-guidance as the gold-standard for TF-TAVR.
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Vol 11 - N° 3
P. e309 - juin 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.