TAVI Procedure Supported by Radial Artery Access Reduces Bleeding Complications

The TAVI procedure, or Transcatheter Aortic Valve Implantation, is a minimally invasive technique in which a new aortic valve is inserted through a femoral artery to replace a narrowed old valve. This method is gaining popularity, particularly among individuals aged 75-80 and those with medical risks, as it is often favored over open-heart surgery, which presents greater risks and necessitates a longer recovery period. In TAVI procedures, two femoral arteries are employed: one for introducing the aortic valve and guiding it to the correct position, and the other for injecting contrast fluid, which enhances visualization of the aorta and ensures precise valve placement. While access through the wrist has become standard practice in procedures like angioplasty to reduce the risk of severe bleeding, this approach has not yet been adopted for TAVI. Now, new research indicates that part of the TAVI procedure can be performed via the radial artery instead of the femoral artery, leading to fewer bleeding complications.

In a randomized study conducted in collaboration with multiple centers, a team of cardiologists and researchers from Radboud University Medical Center (Nijmegen, Netherlands) explored whether this technique, already established in angioplasty procedures, could also benefit the TAVI procedure involving aortic valve replacement. Patients scheduled for TAVI participated in the study and were randomly assigned to one of two groups: the standard procedure using both femoral arteries or the new method where the heart valve was introduced via the femoral artery and the contrast fluid was administered through the radial artery. A total of 238 patients took part in the study, and the findings revealed that serious bleeding requiring medical intervention occurred almost exclusively in the femoral artery group.

Image: Part of the heart surgery TAVI can now be performed via the radial artery instead of the femoral artery (Photo courtesy of Radboudumc)

Additionally, the researchers made another adjustment to the procedure. During TAVI, patients typically receive a temporary pacemaker because the new valve may cause cardiac arrhythmia. While this pacemaker is usually removed immediately after the procedure, it may occasionally remain in place for several days. Traditionally, a femoral vein is used for pacemaker insertion, but in patients who had contrast fluid delivered via the wrist, the pacemaker was instead inserted through an upper-arm vein. This research, published in JAMA Network Open, highlights the advantages of using the radial artery for administering contrast fluid, as it results in fewer bleeding complications. Although this method may take slightly longer than using only femoral arteries, the team anticipates that this approach will be increasingly integrated into practice.

“This is already common in angioplasty, and we have now shown that it also provides advantages in the TAVI procedure,” said Niels van Royen, last author and professor of Cardiology. “We have been performing TAVI procedures for about fifteen years, with promising results. New aortic valves seem to function just as well after ten years as standard surgical valves. If we can reduce the risks associated with the procedure, that would be a significant step forward.”

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Radboud University Medical Center