Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR: The Hostile Registry
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Background: The optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined. Objectives: This study sought to compare clinical outcomes with transfemoral access (TFA), transthoracic access (TTA), and nonthoracic transalternative access (TAA) in TAVR patients with severe PAD. Methods: Patients with PAD and hostile femoral access (TFA impossible, or possible only after percutaneous treatment) undergoing TAVR at 28 international centers were included in this registry. The primary endpoint was the propensity-adjusted risk of 30-day major adverse events (MAE) defined as the composite of all-cause mortality, stroke/transient ischemic attack (TIA), or main access site–related Valve Academic Research Consortium 3 major vascular complications. Outcomes were also stratified according to the severity of PAD using a novel risk score (Hostile score). Results: Among the 1,707 patients included in the registry, 518 (30.3%) underwent TAVR with TFA after percutaneous treatment, 642 (37.6%) with TTA, and 547 (32.0%) with TAA (mostly transaxillary). Compared with TTA, both TFA (adjusted HR: 0.58; 95% CI: 0.45-0.75) and TAA (adjusted HR: 0.60; 95% CI: 0.47-0.78) were associated with lower 30-day rates of MAE, driven by fewer access site–related complications. Composite risks at 1 year were also lower with TFA and TAA compared with TTA. TFA compared with TAA was associated with lower 1-year risk of stroke/TIA (adjusted HR: 0.49; 95% CI: 0.24-0.98), a finding confined to patients with low Hostile scores (Pinteraction = 0.049). Conclusions: Among patients with PAD undergoing TAVR, both TFA and TAA were associated with lower 30-day and 1-year rates of MAE compared with TTA, but 1-year stroke/TIA rates were higher with TAA compared with TFA.
Originalsprog | Engelsk |
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Tidsskrift | JACC: Cardiovascular Interventions |
Vol/bind | 16 |
Udgave nummer | 4 |
Sider (fra-til) | 396-411 |
Antal sider | 16 |
ISSN | 1936-8798 |
DOI | |
Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
The authors thank the following physicians for their participation and invaluable support to the study: Cristina Aurigemma, MD, and Francesco Bianchini, MD (U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy); Taishi Okuno, MD (Inselspital, Bern University Hospital, University of Bern, Switzerland); Francesco Maiellaro, MD (A.O. Mauriziano Umberto I Hospital, Turin, Italy); Hendrik Wienemann, MD (University Hospital Cologne – Heart Center, Klinik III für Innere Medizin - Kardiologie, Pneumologie und internistische Intensivmedizin, Cologne, Germany); Francesco Contorni, MD (Unit of Diagnostic and Interventional Cardiology, C.N.R. Reg. Toscana G. Monasterio Foundation, Ospedale del Cuore, Massa, Italy); Steffen Maassberg, MD (Department of Medicine I, University Hospital Munich, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany); Alexander Sedaghat, MD, and Atsushi Sugiura, MD (Medizinische Klinik und Poliklinik II, Herzzentrum Bonn - Universitätsklinikum Bonn, Bonn, Germany); and Nicolini Elisa, MD (Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I - GM Lancisi, Torette, Ancona, Italy).
Publisher Copyright:
© 2023 American College of Cardiology Foundation
ID: 369993453