TCT-896 Comparative Effectiveness of Balloon Aortic Valvuloplasty From Radial and Femoral Approach as Temporalizing Procedure

Document Type

Conference Proceeding

Publication Date

10-29-2024

Publication Title

J Am Coll Cardiol

Abstract

Background: Balloon aortic valvuloplasty (BAV) is traditionally done over large bore femoral arterial access. We examine the comparative effectiveness of BAV via transfemoral and transradial/transulnar approach. Methods: From 2020-2024, 150 patients with severe aortic stenosis had BAV either via transradial/transulnar access (TR) (n = 100) or transfemoral (TF) (n = 50) approach at a tertiary center in the USA. TR approach was performed using an 8-Fr short sheath when deemed feasible on ultrasound and with 18- to 22-mm balloons sized 1:1 to the left ventricular outflow tract from echocardiogram. Hemodynamic effects, periprocedural outcomes, and transcatheter aortic valve replacement (TAVR) was recorded. Results: TR approach was feasible in 90.4% of patients. Switch-over to femoral approach due to spasm or calcium occurred in 2% patients. Vessel patency was preserved in 95.9%. End-stage kidney disease, female sex, and low body weight were independent predictors of unfeasible TR approach on multivariate analysis. Compared with TF, TR approach had shorter procedure time (59 vs 83 min), lower contrast volume (16 vs 31 mL), shorter time to discharge (2 vs 5 days), less bleeding: VARC-II major bleed 3% vs 12%; and less vascular complication: VARC-II major 1% vs 10%, all P < 0.05 after multivariate adjustment. Hemodynamic success was comparable 87% TR 84% TF. Twenty-two percent of TF and 27% of TR group required more than 2 balloon inflation and pacing runs. Intraprocedural hypotension, stroke, and increased aortic insufficiency rates were not statistically different: 12% TF vs 4% TR for hypotension; 2% TF 1 % TR for stroke. Thirty percent TF 35% TR for increased AI (none severe) (all P>=0.05). There was no statistically significant difference in time-to-event for a composite of heart failure/unplanned hospitalization and all-cause mortality at 90 days, 27% TR, 36% TF, log-rank P = 0.56. Kaplan-Meier showed a trend toward earlier TAVR in TR group at 90 days, log-rank P = 0.0554; 44% TF vs 60.2%. Conclusion: BAV via TR approach is feasible in most patients and associated with quicker procedure and discharge, less vascular and bleeding complication, similar hemodynamic result compared with TF, and possible trend toward quicker transition to TAVR. Categories: STRUCTURAL: Valvular Disease: Aortic.

Volume

84

Issue

18

First Page

B377

Last Page

B378

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