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Transradial cardiac catheterization in liver transplant candidates
Chetan P Huded1, John E Blair1, Ranya N Sweis1
1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
Transradial cardiac catheterization is safe and effective for liver transplant candidates. This study found similar radial approach failure rates and no increased adverse events in liver transplant candidates compared to other patients.
Area of Science:
- Cardiology
- Transplant Surgery
- Vascular Access
Background:
- Transradial (TR) cardiac catheterization offers advantages over transfemoral approaches, including reduced vascular complications and bleeding.
- Liver transplant candidates (LTCs) represent a unique patient population with specific physiological characteristics that may influence procedural safety.
Purpose of the Study:
- To evaluate the safety and feasibility of transradial cardiac catheterization in liver transplant candidates.
- To compare the radial approach failure rate and adverse events between LTCs and non-LTCs undergoing cardiac catheterization.
Main Methods:
- Retrospective review of 1,071 consecutive transradial cardiac catheterization cases in 1,045 patients.
- Comparison of procedural outcomes and patient characteristics between 107 LTCs and 964 non-LTCs.
- Analysis of primary endpoint: radial approach failure.
Main Results:
- Radial approach failure rates were similar between LTCs (10%) and non-LTCs (7%), with no statistically significant difference (p = 0.15).
- LTCs exhibited significantly lower platelet counts, higher international normalized ratio, and lower mean arterial pressure compared to non-LTCs.
- Despite these differences, the incidence of adverse events was comparable between the two groups.
Conclusions:
- Transradial cardiac catheterization is a safe and effective procedure for liver transplant candidates.
- The unique hematological and hemodynamic profiles of LTCs do not appear to increase the risk of adverse events during transradial cardiac catheterization.
Abstract:
Transradial (TR) cardiac catheterization is effective and offers lower rates of vascular complications and bleeding compared with transfemoral cardiac catheterization. We sought to describe the safety and feasibility of TR cardiac catheterization in liver transplant candidates (LTCs). We retrospectively reviewed 1,071 consecutive cases of TR cardiac catheterization in 1,045 patients from May 2008 to December 2011 at a single institution. The primary end point was radial approach failure. Ten percent of TR cases (n = 107) were performed in LTCs and 90% (n = 964) were performed in non-LTCs. The LTC group had lower rates of cardiovascular diseases and cardiovascular risk factors. The LTC group had a significantly lower platelet count (75,000 vs 237,000/mm(3), p <0.01), higher international normalized ratio (1.7 vs 1.1, p <0.01), and lower mean arterial pressure (78 vs 89 mm Hg, p <0.01). The mean Model for End-Stage Liver Disease score was 21 in LTCs. Percutaneous coronary interventions were performed in 4% of LTCs and 15% of non-LTCs (p <0.01). The radial approach failure rate was 10% in LTCs and 7% in non-LTCs (p = 0.15). In conclusion, radial approach failure was similar between the LTC and non-LTC groups. Despite significant differences in platelet count and international normalized ratio, there was no difference in the incidence of adverse events between the groups, suggesting that TR cardiac catheterization is safe and effective in LTCs.
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