Unilateral-access vs. bilateral-access in transfemoral transcatheter aortic valve replacement: A slim fit approach

Ana Rita Pereira; Ahmed A M Al Jaff; Jose Montero Cabezas; Arend de Weger; Dario Candura; Johan Wouter Jukema; Fatih Arslan; Madelien V Regeer; Nina Ajmone Marsan; Frank van der Kley

doi:10.1016/j.ijcard.2024.132712

Unilateral-access vs. bilateral-access in transfemoral transcatheter aortic valve replacement: A slim fit approach

Int J Cardiol. 2024 Nov 15:420:132712. doi: 10.1016/j.ijcard.2024.132712. Online ahead of print.

Affiliations

¹ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
² Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
³ Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
⁴ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; The Netherlands Heart Institute, Utrecht, the Netherlands.
⁵ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: f.van_der_kley@lumc.nl.

PMID: 39549774
DOI: 10.1016/j.ijcard.2024.132712

Abstract

Background: Vascular complications remain prevalent on transfemoral transcatheter aortic valve replacement (TF-TAVR) with a significant proportion related to the secondary arterial access. We hypothesized that placing the second sheath ipsilateral and distal to the delivery sheath could reduce vascular complications with similar safety and efficacy.

Objectives: Comparing vascular complications and clinical outcomes when placing the secondary arterial sheath in the ipsilateral (unilateral-access) versus in the contralateral (bilateral-access) femoral artery during TF-TAVR.

Methods: Patients who underwent TF-TAVR using unilateral-access as first-choice approach were retrospectively compared with a contemporaneous bilateral-access group. The primary endpoint was the incidence of vascular complications related to femoral access according to the VARC-3 criteria. A propensity-score analysis was performed accounting for the differences in clinical, vascular, and procedural characteristics.

Results: A total of 217 patients were included, of whom 150 (69.1 %) underwent TF-TAVR through bilateral- and 67 (30.9 %) through unilateral-access. Vascular complications occurred in 16.0 % of the bilateral-access group and 10.4 % of the unilateral-access group (p = 0.280). The unilateral-access group achieved high procedural success with normalization of peak aortic velocity and low rates of paravalvular leaks, valve migration and pacemaker requirement. After propensity-score matching, the overall complications rate was superior in the bilateral-access group (54.4 % vs 35.1 %, p = 0.038) due to a trend of higher vascular complications (26.3 % vs 12.3 %, p = 0.058) and a significant higher occurrence of bleeding complications (17.5 % vs 1.8 %, p = 0.008).

Conclusions: Unilateral-access TF-TAVR is feasible, safe, and potentially enhances procedural efficiency and patient satisfaction while maintaining the capacity for bailout interventions in managing vascular complications.