Abstract
Background: Transfemoral access is the default approach for transcatheter aortic valve implantation (TAVI) and left atrial appendage closure (LAAC). Although ultrasound (US)-guided femoral puncture improves first-pass success and reduces vascular complications in randomized trials, real-world data in contemporary structural heart interventions, including both arterial and venous large-sheath access, remain limited. The authors aimed to compare US-guided vs. conventional transfemoral access in patients undergoing TAVI and LAAC.
Methods: This single-center, retrospective cohort study included 165 consecutive patients undergoing transfemoral structural procedures between January 2022 and December 2024 (93: TAVI; 72: LAAC). Ultrasound guidance was used in 57 procedures (34.5%). Arterial and venous cohorts were analyzed separately. Primary outcomes were absolute hemoglobin decrease (ΔHb) and access-site vascular complications (hematoma, pseudoaneurysm, and arteriovenous fistula). In the arterial cohort, 1 : 1 propensity score matching was performed to adjust for baseline differences.
Results: Hemoglobin decline was significantly smaller with US guidance in both venous
(0.80 ± 0.95 vs. 1.50 ± 1.11 g/dL; P = .009) and arterial procedures (0.58 ± 0.97 vs. 1.29 ± 1.00 g/dL; P = .002). In the venous cohort, complication rates were numerically lower but not statistically different (3.8% vs. 17.4%; P = .143). In contrast, arterial complications were significantly reduced with US guidance. After propensity matching (31 patients per group),
complications occurred in 3.2% vs. 29.0% [Absolute Risk Reduction(ARR) = 25.8%, Number Need to Treat (NNT) = 4, P = .013].
Conclusions: Ultrasound-guided transfemoral access was associated with reduced hemoglobin decline and fewer vascular complications, particularly in large-bore arterial procedures, supporting routine integration of real-time US guidance in structural interventions.