Coronary Artery Disease
Transradial Cardiac Catheterization in Liver Transplant Candidates

https://doi.org/10.1016/j.amjcard.2014.02.014Get rights and content

Transradial (TR) cardiac catheterization is effective and offers lower rates of vascular complications and bleeding compared with transfemoral cardiac catheterization. We sought to describe the safety and feasibility of TR cardiac catheterization in liver transplant candidates (LTCs). We retrospectively reviewed 1,071 consecutive cases of TR cardiac catheterization in 1,045 patients from May 2008 to December 2011 at a single institution. The primary end point was radial approach failure. Ten percent of TR cases (n = 107) were performed in LTCs and 90% (n = 964) were performed in non-LTCs. The LTC group had lower rates of cardiovascular diseases and cardiovascular risk factors. The LTC group had a significantly lower platelet count (75,000 vs 237,000/mm3, p <0.01), higher international normalized ratio (1.7 vs 1.1, p <0.01), and lower mean arterial pressure (78 vs 89 mm Hg, p <0.01). The mean Model for End-Stage Liver Disease score was 21 in LTCs. Percutaneous coronary interventions were performed in 4% of LTCs and 15% of non-LTCs (p <0.01). The radial approach failure rate was 10% in LTCs and 7% in non-LTCs (p = 0.15). In conclusion, radial approach failure was similar between the LTC and non-LTC groups. Despite significant differences in platelet count and international normalized ratio, there was no difference in the incidence of adverse events between the groups, suggesting that TR cardiac catheterization is safe and effective in LTCs.

Section snippets

Methods

We retrospectively reviewed all cases of TR cardiac catheterization at our institution from adoption of the TR approach until the time of this study. This included 1,071 consecutive cases of TR cardiac catheterization performed in 1,045 patients from May 2008 to December 2011. All cases were included in this analysis. Clinical, demographic, and procedural variables were collected by review of the medical records, procedure logs, digital angiograms, and the Social Security Death Index.

Results

There were 1,071 TR cases included in the analysis. Ten percent of cases (n = 107) were performed in LTCs, and the remaining 90% (n = 964) were performed in non-LTCs. Baseline demographics are compared in Table 1. There were several notable differences between the LTC and non-LTC groups. The LTC group had a higher proportion of men. The LTC group had lower rates of hypertension, dyslipidemia, CAD, congestive heart failure, and peripheral vascular disease. Systolic blood pressure, diastolic

Discussion

These findings highlight the safety and efficacy of TR cardiac catheterization in the preoperative risk stratification of LTCs. TR cardiac catheterization was accomplished successfully in 90% of patients in the LTC group. Other studies have also shown TR failure rates from 2% to 10% for all patients undergoing TR cardiac catheterization. One recent series showed a TR failure rate of 9.1% in a single institution after a 6-month transition period from predominantly TF approach to predominantly TR

Disclosures

The authors report no disclosures or conflicts of interest in preparing this manuscript.

References (24)

  • F. Burzotta et al.

    Vascular complications and access crossover in 10,676 transradial percutaneous coronary procedures

    Am Heart J

    (2012)
  • J.C. Townsend et al.

    Usefulness of international normalized ratio to predict bleeding complications in patients with end-stage liver disease who undergo cardiac catheterization

    Am J Cardiol

    (2012)

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