TY - JOUR

T1 - Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR

T2 - The Hostile Registry

AU - Palmerini, Tullio

AU - Saia, Francesco

AU - Kim, Won Keun

AU - Renker, Matthias

AU - Iadanza, Alessandro

AU - Fineschi, Massimo

AU - Bruno, Antonio Giulio

AU - Ghetti, Gabriele

AU - Vanhaverbeke, Maarten

AU - Søndergaard, Lars

AU - De Backer, Ole

AU - Romagnoli, Enrico

AU - Burzotta, Francesco

AU - Trani, Carlo

AU - Adrichem, Rik

AU - Van Mieghem, Nicolas M.

AU - Nardi, Elena

AU - Chietera, Francesco

AU - Orzalkiewicz, Mateusz

AU - Tomii, Daijiro

AU - Pilgrim, Thomas

AU - Aranzulla, Tiziana Claudia

AU - Musumeci, Giuseppe

AU - Adam, Matti

AU - Meertens, Max M.

AU - Taglieri, Nevio

AU - Marrozzini, Cinzia

AU - Alvarez Covarrubias, Hector Alfonso

AU - Joner, Michael

AU - Nardi, Giulia

AU - Di Muro, Francesca Maria

AU - Di Mario, Carlo

AU - Loretz, Lucca

AU - Toggweiler, Stefan

AU - Gallitto, Enrico

AU - Gargiulo, Mauro

AU - Testa, Luca

AU - Bedogni, Francesco

AU - Berti, Sergio

AU - Ancona, Marco B.

AU - Montorfano, Matteo

AU - Leone, Alessandro

AU - Savini, Carlo

AU - Pacini, Davide

AU - Gmeiner, Jonas

AU - Braun, Daniel

AU - Nerla, Roberto

AU - Castriota, Fausto

AU - De Carlo, Marco

AU - Petronio, Anna Sonia

AU - Barbanti, Marco

AU - Costa, Giuliano

AU - Tamburino, Corrado

AU - Leone, Pier Pasquale

AU - Reimers, Bernhard

AU - Stefanini, Giulio

AU - Sudo, Mitsumasa

AU - Nickenig, Georg

AU - Piva, Tommaso

AU - Scotti, Andrea

AU - Latib, Azeem

AU - Vercellino, Matteo

AU - Porto, Italo

AU - Codner, Pablo

AU - Kornowski, Ran

AU - Bartorelli, Antonio L.

AU - Tarantini, Giuseppe

AU - Fraccaro, Chiara

AU - Abdel-Wahab, Mohamed

AU - Grube, Eberhard

AU - Galié, Nazzareno

AU - Stone, Gregg W.

N1 - Publisher Copyright: © 2023 American College of Cardiology Foundation

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - alternative access

KW - critical patient

KW - femoral access

KW - transcatheter aortic valve replacement

UR - http://www.scopus.com/inward/record.url?scp=85148365693&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2022.12.009

DO - 10.1016/j.jcin.2022.12.009

M3 - Journal article

C2 - 36858659

AN - SCOPUS:85148365693

VL - 16

SP - 396

EP - 411

JO - J A C C: Cardiovascular Interventions

JF - J A C C: Cardiovascular Interventions

SN - 1936-8798

IS - 4

ER -