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Ultrasound-Guided Transfemoral Access for Coronary Procedures: A Pooled Learning Curve Analysis From the FAUST and UNIVERSAL Trials.
d'Entremont, Marc-André; Seto, Arnold H; Alrashidi, Sulaiman; Alansari, Omar; Brochu, Bradley; Lemaire-Paquette, Samuel; Heenan, Laura; Skuriat, Elizabeth; Tyrwhitt, Jessica; Raco, Michael; Tsang, Michael B; Valettas, Nicholas; Velianou, James; Sheth, Tej; Sibbald, Matthew; Mehta, Shamir R; Pinilla-Echeverri, Natalia; Schwalm, Jon-David; Natarajan, Madhu K; Abu-Fadel, Mazen; Kelly, Andrew; Akl, Elie; Tawadros, Sarah; Faidi, Walaa; Bauer, John; Moxham, Rachel; Nkurunziza, James; Dutra, Gustavo; Winter, Jose; Couture, Étienne L; Jolly, Sanjit S.
Afiliação
  • d'Entremont MA; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).
  • Seto AH; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
  • Alrashidi S; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).
  • Alansari O; Centre Hospitalier Universitaire de Sherbrooke, QC, Canada (M.-A.d., S.L.-P., E.L.C.).
  • Brochu B; Long Beach VA Medical Center, CA (A.H.S.).
  • Lemaire-Paquette S; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
  • Heenan L; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).
  • Skuriat E; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
  • Tyrwhitt J; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).
  • Raco M; CK Hui Heart Center, Edmonton, AB, Canada (B.B.).
  • Tsang MB; Centre Hospitalier Universitaire de Sherbrooke, QC, Canada (M.-A.d., S.L.-P., E.L.C.).
  • Valettas N; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).
  • Velianou J; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).
  • Sheth T; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).
  • Sibbald M; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
  • Mehta SR; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).
  • Pinilla-Echeverri N; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
  • Schwalm JD; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).
  • Natarajan MK; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
  • Abu-Fadel M; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).
  • Kelly A; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
  • Akl E; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).
  • Tawadros S; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).
  • Faidi W; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
  • Bauer J; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).
  • Moxham R; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
  • Nkurunziza J; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).
  • Dutra G; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).
  • Winter J; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
  • Couture ÉL; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).
  • Jolly SS; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).
Circ Cardiovasc Interv ; : e013817, 2024 Jun 18.
Article em En | MEDLINE | ID: mdl-38887948
ABSTRACT

BACKGROUND:

The learning curve for new operators performing ultrasound-guided transfemoral access (TFA) remains uncertain.

METHODS:

We performed a pooled analysis of the FAUST (Femoral Arterial Access With Ultrasound Trial) and UNIVERSAL (Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures) trials, both multicenter randomized controlled trials of 11 ultrasound-guided versus non-ultrasound-guided TFA for coronary procedures. Outcomes included the composite of major bleeding or vascular complications and successful common femoral artery cannulation. Participants were stratified by the operators' accrued case volume. We used adjusted repeated-measurement logistic regression, with random intercepts for operator clustering, for comparison against the non-ultrasound-guided TFA group and to model the learning curve.

RESULTS:

The FAUST and UNIVERSAL trials randomized a total of 1624 patients, of which 810 were randomized to non-ultrasound-guided TFA and 814 to ultrasound-guided TFA (cases 1-10, 391; 11-20, 183; and >20, 240). Participants who had operators who performed >20 ultrasound-guided TFAs had a decreased risk for the primary end point (5/240 [2.1%] versus 64/810 [7.9%]; adjusted odds ratio, 0.26 [95% CI, 0.09-0.61]) compared with non-ultrasound-guided TFA. Operators who performed >20 ultrasound-guided procedures had increased odds of successfully cannulating the common femoral artery (224/246 [91.1%] versus 327/382 [85.6%]; adjusted odds ratio, 1.76 [95% CI, 1.08-2.89]) compared with non-ultrasound-guided TFA. The learning curve plots demonstrated growing competence with increasing accrued cases.

CONCLUSIONS:

New operators should perform at least 20 ultrasound-guided TFA to decrease access site complications and increase proper cannulation compared with non-ultrasound-guided TFA. Additional accrued cases may lead to increased proficiency. Training programs should consider these findings in the transradial era.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Circ Cardiovasc Interv Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2024 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Circ Cardiovasc Interv Assunto da revista: ANGIOLOGIA / CARDIOLOGIA Ano de publicação: 2024 Tipo de documento: Article