Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://hdl.handle.net/10216/134485 |
Resumo: | Introduction and Objectives: Transcatheter aortic valve implantation (TAVI) is an increasingly used technique. The use of ultrasound guidance for femoral artery puncture can reduce vascular and bleeding access-related complications. The objectives of this study were: 1) to evaluate the impact of echo-guided access on TAVI-related vascular and bleeding complications and 30-day mortality and 2) to identify the predictors of these outcomes. Methods: Patients who underwent transfemoral TAVI between January and December 2017 (fluoroscope-guided access) and between June 2018 and May 2019 (echo-guided access) were included (n=230). The occurrence of vascular and bleeding complications, 30-day mortality and the composite endpoints of 1) any vascular or bleeding complications; and 2) any vascular or bleeding complications or the need for transfusion of ≥2 units of red blood cells (URBC) between the two groups were compared. Results: Haemorrhage (24,3% vs 9,4%, p=0,003), vascular complications (27,7% vs 16,9%, p=0,05) and 30-day mortality (13,9% vs 1,8%, p=0,001) were more common in the fluoroscopy-guided group. In multivariable regression, the use of echo-guided access was an independent predictor of less haemorrhage (OR=0,408, IC95% 0,170-0,82, p=0,045) and the composite of any vascular or bleeding complication or the need for transfusion of ≥2 URBC (OR=0,509, IC95% 0,264-0,979, p=0,043). A BMI greater than 26,64 kg/m2 was protective against vascular complications (11,6% vs 36,4%, p<0,001). Concerning 30-day mortality, echo-guided access did not remain a predictor after adjusting for EuroSCORE II. Conclusion: Echo-guided accesses reduced TAVI-related vascular and bleeding complications and 30-day mortality. BMI was associated with fewer vascular complications, highlighting the obesity paradox associated with TAVI procedures. |
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Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutâneaMedicina clínicaClinical medicineIntroduction and Objectives: Transcatheter aortic valve implantation (TAVI) is an increasingly used technique. The use of ultrasound guidance for femoral artery puncture can reduce vascular and bleeding access-related complications. The objectives of this study were: 1) to evaluate the impact of echo-guided access on TAVI-related vascular and bleeding complications and 30-day mortality and 2) to identify the predictors of these outcomes. Methods: Patients who underwent transfemoral TAVI between January and December 2017 (fluoroscope-guided access) and between June 2018 and May 2019 (echo-guided access) were included (n=230). The occurrence of vascular and bleeding complications, 30-day mortality and the composite endpoints of 1) any vascular or bleeding complications; and 2) any vascular or bleeding complications or the need for transfusion of ≥2 units of red blood cells (URBC) between the two groups were compared. Results: Haemorrhage (24,3% vs 9,4%, p=0,003), vascular complications (27,7% vs 16,9%, p=0,05) and 30-day mortality (13,9% vs 1,8%, p=0,001) were more common in the fluoroscopy-guided group. In multivariable regression, the use of echo-guided access was an independent predictor of less haemorrhage (OR=0,408, IC95% 0,170-0,82, p=0,045) and the composite of any vascular or bleeding complication or the need for transfusion of ≥2 URBC (OR=0,509, IC95% 0,264-0,979, p=0,043). A BMI greater than 26,64 kg/m2 was protective against vascular complications (11,6% vs 36,4%, p<0,001). Concerning 30-day mortality, echo-guided access did not remain a predictor after adjusting for EuroSCORE II. Conclusion: Echo-guided accesses reduced TAVI-related vascular and bleeding complications and 30-day mortality. BMI was associated with fewer vascular complications, highlighting the obesity paradox associated with TAVI procedures.2021-04-272021-04-27T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttps://hdl.handle.net/10216/134485TID:202848884porInês Maria Arrobas Rodriguesinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-11-29T15:07:00Zoai:repositorio-aberto.up.pt:10216/134485Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T00:15:57.812306Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea |
title |
Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea |
spellingShingle |
Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea Inês Maria Arrobas Rodrigues Medicina clínica Clinical medicine |
title_short |
Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea |
title_full |
Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea |
title_fullStr |
Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea |
title_full_unstemmed |
Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea |
title_sort |
Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea |
author |
Inês Maria Arrobas Rodrigues |
author_facet |
Inês Maria Arrobas Rodrigues |
author_role |
author |
dc.contributor.author.fl_str_mv |
Inês Maria Arrobas Rodrigues |
dc.subject.por.fl_str_mv |
Medicina clínica Clinical medicine |
topic |
Medicina clínica Clinical medicine |
description |
Introduction and Objectives: Transcatheter aortic valve implantation (TAVI) is an increasingly used technique. The use of ultrasound guidance for femoral artery puncture can reduce vascular and bleeding access-related complications. The objectives of this study were: 1) to evaluate the impact of echo-guided access on TAVI-related vascular and bleeding complications and 30-day mortality and 2) to identify the predictors of these outcomes. Methods: Patients who underwent transfemoral TAVI between January and December 2017 (fluoroscope-guided access) and between June 2018 and May 2019 (echo-guided access) were included (n=230). The occurrence of vascular and bleeding complications, 30-day mortality and the composite endpoints of 1) any vascular or bleeding complications; and 2) any vascular or bleeding complications or the need for transfusion of ≥2 units of red blood cells (URBC) between the two groups were compared. Results: Haemorrhage (24,3% vs 9,4%, p=0,003), vascular complications (27,7% vs 16,9%, p=0,05) and 30-day mortality (13,9% vs 1,8%, p=0,001) were more common in the fluoroscopy-guided group. In multivariable regression, the use of echo-guided access was an independent predictor of less haemorrhage (OR=0,408, IC95% 0,170-0,82, p=0,045) and the composite of any vascular or bleeding complication or the need for transfusion of ≥2 URBC (OR=0,509, IC95% 0,264-0,979, p=0,043). A BMI greater than 26,64 kg/m2 was protective against vascular complications (11,6% vs 36,4%, p<0,001). Concerning 30-day mortality, echo-guided access did not remain a predictor after adjusting for EuroSCORE II. Conclusion: Echo-guided accesses reduced TAVI-related vascular and bleeding complications and 30-day mortality. BMI was associated with fewer vascular complications, highlighting the obesity paradox associated with TAVI procedures. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-04-27 2021-04-27T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://hdl.handle.net/10216/134485 TID:202848884 |
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https://hdl.handle.net/10216/134485 |
identifier_str_mv |
TID:202848884 |
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por |
language |
por |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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