Procedural and Clinical Outcomes According to Ultrasound-Guided Access in TAVI: A Propensity-Matched Comparative Subanalysis From the PULSE Registry

BACKGROUND: Access-related vascular and bleeding complications during transcatheter aortic valve implantation (TAVI) are associated with significant morbidity and mortality. Ultrasound-guided (USG) puncture may reduce the incidence of these adverse events, particularly in large-bore arterial access. However, large-scale data on this approach are limited, and it has not yet been fully implemented into standard clinical practice. We compared access-related vascular and bleeding complications in USG versus fluoroscopy-guided access from a large multicenter TAVI registry. METHODS: The PULSE registry (Plug- or Suture-Based Vascular Closure After TAVI) retrospectively evaluated data of 9295 patients who underwent transfemoral TAVI at 10 high-volume German heart centers (2016–2021). USG and fluoroscopy-guided access were performed in 1992 (21.4%) and 7303 (78.6%) patients, respectively. Propensity score matching (1:1) yielded 895 matched pairs. The primary end point, a composite of minor and major vascular complications or bleeding type II-IV, was assessed according to Valve Academic Research Consortium definitions. RESULTS: Patients in the USG and fluoroscopy-guided groups (median age, 81.9 [78.3–85.0] years; 47.8% female patients) showed well-balanced baseline characteristics. The overall risk profile was comparable (median EuroSCORE II: 3.2 versus 3.5; SD, 0.007 [−0.086 to 0.099]). The composite primary end point occurred less frequently in the USG group (11.7% versus 16.0%; odds ratio, 0.7; P =0.01), driven by lower rates of procedural bleeding (5.4% versus 9.2%; odds ratio, 0.56; P =0.002) and with lower rates of endovascular treatment (0.7% versus 2.5%; P =0.005). CONCLUSIONS: In patients with transfemoral TAVI, USG access demonstrated lower rates of access-related vascular complications and type II-IV bleeding compared with fluoroscopy-guided access. Implementing USG puncture as the standard of care may improve access-related outcomes after TAVI.