Femoral vascular access complications after transcatheter aortic valve implantation (TAVI) in a high complexity hospital in Spain

Introduction: transcatheter aortic valve implantation (TAVI) has been associated with various complications, including vascular access complications (VACs); which can be serious due to the diameter (profile) of the devices, failure or inappropriate use of percutaneous closure devices and the patients' own comorbidities. Methods: we conducted a retrospective single-center study from 2017 through 2021 aiming to primarily examine demographic characteristics, types of complications, laterality of the complication, treatments applied, use of closure device, as well as secondarily assess mortality and the length of stay in patients undergoing transcatheter aortic valve implantation. Qualitative variables were expressed as absolute frequencies and percentages. To express quantitative variables we used means and statistical inferences with the chi-square test. No multivariate analysis was performed. Results: a total of 346 TAVIs were performed in the period described. A total of 20.1 % patients (77) presented a VAC [53.2 % men (41), with a mean age of 80.28 (DS, 6,4)]. The primary access was significantly associated with VAC (9.53 % vs 1.15 %; p < 0.05). The pre-TAVI protocol, with cardiac catheterization or CCTA was performed in 71.9 % of cases (249). The presence of aorto-iliac disease in the pre-TAVI protocol showed a significant difference between the VAC and non-VAG group, with an incidence rate of 26.7 % vs 16.06 %, respectively (p < 0.05). The most frequent postoperative complication was femoral pseudoaneurysm in 52.1 %. The use of protamine during the procedure was significantly associated with fewer complications (10.4 vs 18.6 %, p < 0.05). The mean stay was longer in patients with VAC, 12.01 (SD, 9.4) vs 7.24 days (SD, 12.3) (IC 95 %, 3.1-6.4; p < 0.05). Overall mortality after TAVI was 2.89 % (10), in VAC patients the mortality rate was 1.29 % (1/77) and in non-VAC patients, 3.34 % (9/269), (p > 0.05). Conclusion: the incidence of vascular complications in our center is significant, and often associated with longer lengths of stay, not with mortality.