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Published on: October 20, 2023
Hemodynamic Assessment of Severe Aortic Stenosis via Transradial Approach is Safe
Kintur Sanghvi1, Samir Pancholy, Tejas Patel
1Deborah Heart & Lung Center, 200 Trenton Road, Browns Mills, NJ 08015 USA. sanghvik@deborah.org.
Insights
Transradial cardiac catheterization is a safe and feasible approach for assessing severe aortic stenosis, showing fewer access-site complications than the transfemoral method. This technique allows for effective hemodynamic assessment in complex patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Patients with aortic stenosis (AS) often require invasive hemodynamic assessment when clinical findings and echocardiography disagree.
- The safety and feasibility of transradial cardiac catheterization (TR-cath) versus transfemoral cardiac catheterization (TF-cath) in this complex population are not well-established.
Purpose of the Study:
- To compare the safety, feasibility, and procedural efficiency of the transradial approach versus the transfemoral approach for assessing severe aortic stenosis.
- To evaluate the rate of access-site complications and cerebrovascular events between the two approaches.
Main Methods:
- Retrospective evaluation of patients with severe AS (aortic valve area <1.0 cm²) who underwent cardiac catheterization over two years.
- Comparison of demographic, clinical, and procedural data between the transradial (TR) group and transfemoral (TF) group.
Main Results:
- Transradial cardiac catheterization (TR-cath) was feasible in 58 patients, compared to 176 in the transfemoral (TF) group.
- Fluoroscopy time and time to cross the aortic valve were comparable between TR and TF groups (P=.23 and P=.39, respectively).
- Access-site complications were significantly lower in the TR group (0%) compared to the TF group (5.11%; P<.01).
Conclusions:
- Transradial retrograde crossing of severely stenosed aortic valves is feasible with standard equipment.
- The transradial approach offers reduced access-site related complications for assessing severe aortic stenosis.
Background:
Patients with a discrepancy between clinical presentation and echocardiographic severity of aortic stenosis require invasive hemodynamic assessment. The comparative safety and feasibility of transradial cardiac catheterization in comparison with the traditional transfemoral approach in this usually complex subset of patients is not known. We sought to evaluate the safety, feasibility, and time to cross severely stenosed aortic valves via radial approach.
Methods:
All patients who were successfully assessed for aortic stenosis with a dual-lumen catheter and found to have severe aortic stenosis (calculated aortic valve area <1.0 cm2) in the last 2 years at our institution were retrospectively evaluated. Demographic, clinical, and procedural data were compared between the TF group (femoral arterial and venous access) and TR group (radial artery and basilic or cephalic vein access).
Results:
A total of 176 patients underwent left and right heart catheterization using femoral access, while 58 patients had their procedures performed via radial artery and arm vein access. Fluoroscopy time was comparable between TR and TF groups (14.97 ± 4.6 minutes vs 12.90 ± 3.9 minutes, respectively; P=.23), as was the time to cross the aortic valve (132 ± 209 seconds vs 128 ± 226 seconds, respectively; P=.39). Incidence of cerebrovascular events was not different between the two groups (2.3% vs 1.75%, respectively; P=.14). Access-site complications were significantly higher in the TF group vs the TR group (5.11% vs 0%, respectively; P<.01).
Conclusion:
Transradial retrograde crossing of severely stenosed aortic valve is feasible using ordinary equipment, with reduced access-site related complications.
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