Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2026
Extremity Function After Transfemoral Transcatheter Aortic Valve Implantation: A TAVI XS Sub-Study.
СтатьяРандомизированное исследованиеСравнительное исследованиеМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Versteeg Geert A A, Rooijakkers Maxim J P, Hemelrijk Kimberley I, Vlaar Pieter J, Overduin Daniël C, van Wely Marleen H, Aarts Hugo M, van Ginkel Dirk-Jan, Stens Niels A, van Nunen Lokien X, van Geuns Robert Jan, van Garsse Leen A F M, Geuzebroek Guillaume S C, Verkroost Michel W A, Cetinyurek-Yavuz Aysun, Heijmen Robin H, Thijssen Dick H J, Ten Berg Jurrien M, Tonino Pim A L, Delewi Ronak, van Royen Niels
Аннотация
BACKGROUND: Physical decline after transcatheter aortic valve implantation (TAVI) is associated with worse outcomes. However, data on post-TAVI extremity function are limited. This sub-study of the TAVI XS trial aimed to assess extremity function after transfemoral TAVI, evaluate functional decline, compare outcomes between upper-and lower-extremity secondary access approaches and identify predictors of functional decline after TAVI.
METHODS: The TAVI XS was a randomized clinical trial comparing upper- and lower-extremity secondary access during TAVI. Patients were assessed for extremity function at baseline and at 30 days using the Lower Extremity Function Scale (higher score indicating better function) and the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (higher score indicating worse function).
RESULTS: Lower-extremity (45.0 [IQR 35.0-57.0] to 52.0 [39.0-63.0]; p < 0.001), and upper-extremity function (11.4 [2.3-25.0] to 6.8 [0-22.7]; p = 0.003) improved after TAVI. Relevant decline in lower-extremity function occurred in 20 (8.4%) patients, and in upper-extremity function in 19 (8.0%) patients. No differences in post-TAVI function were observed between upper- or lower-extremity secondary access (lower-extremity: 10.1% vs. 6.7%; p = 0.35, upper-extremity: 7.6% vs. 8.4%; p = 0.81). Predictors (OR [95% CI]) of clinically relevant decline were baseline use of dual antiplatelet therapy/oral anticoagulants (4.17 [1.39-12.49]; p = 0.01) for lower-extremity function and multiple punctures (4.05 [1.46-11.24]; p = 0.007) for upper-extremity function. Age inversely affected lower- (0.92 [0.85-0.99/year]; p = 0.02) and upper-extremity function (0.93 [0.86-0.99/year]; p = 0.04).
CONCLUSIONS: The incidence of clinically relevant decline in extremity function after TAVI is low. No differences in reported extremity function were observed between the upper- and lower-extremity secondary access approach. Predictors of decline were antithrombotic therapy and multiple punctures.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05672823.
METHODS: The TAVI XS was a randomized clinical trial comparing upper- and lower-extremity secondary access during TAVI. Patients were assessed for extremity function at baseline and at 30 days using the Lower Extremity Function Scale (higher score indicating better function) and the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (higher score indicating worse function).
RESULTS: Lower-extremity (45.0 [IQR 35.0-57.0] to 52.0 [39.0-63.0]; p < 0.001), and upper-extremity function (11.4 [2.3-25.0] to 6.8 [0-22.7]; p = 0.003) improved after TAVI. Relevant decline in lower-extremity function occurred in 20 (8.4%) patients, and in upper-extremity function in 19 (8.0%) patients. No differences in post-TAVI function were observed between upper- or lower-extremity secondary access (lower-extremity: 10.1% vs. 6.7%; p = 0.35, upper-extremity: 7.6% vs. 8.4%; p = 0.81). Predictors (OR [95% CI]) of clinically relevant decline were baseline use of dual antiplatelet therapy/oral anticoagulants (4.17 [1.39-12.49]; p = 0.01) for lower-extremity function and multiple punctures (4.05 [1.46-11.24]; p = 0.007) for upper-extremity function. Age inversely affected lower- (0.92 [0.85-0.99/year]; p = 0.02) and upper-extremity function (0.93 [0.86-0.99/year]; p = 0.04).
CONCLUSIONS: The incidence of clinically relevant decline in extremity function after TAVI is low. No differences in reported extremity function were observed between the upper- and lower-extremity secondary access approach. Predictors of decline were antithrombotic therapy and multiple punctures.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05672823.
Предметные рубрики MeSH
HumansFemaleAged, 80 and overTreatment OutcomeTime FactorsRecovery of FunctionAortic Valve StenosisFemoral ArteryTranscatheter Aortic Valve ReplacementMaleRisk FactorsCatheterization, PeripheralAgedLower ExtremityUpper ExtremityFunctional StatusDisability EvaluationAortic ValvePlatelet Aggregation InhibitorsPunctures