Femoral Versus Nonfemoral Peripheral Access for Transcatheter Aortic Valve Replacement.
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Beurtheret Sylvain, Karam Nicole, Resseguier Noemie, Houel Remi, Modine Thomas, Folliguet Thierry, Chamandi Chekrallah, Com Olivier, Gelisse Richard, Bille Jacques, Joly Patrick, Barra Nicolas, Tavildari Alain, Commeau Philippe, Armero Sebastien, Pankert Mathieu, Pansieri Michel, Siame Sabrina, Koning René, Laskar Marc, Le Dolley Yvan, Maudiere Arnaud, Villette Bertrand, Khanoyan Patrick, Seitz Julien, Blanchard Didier, Spaulding Christian, Lefevre Thierry, Van Belle Eric, Gilard Martine, Eltchaninoff Helene, Iung Bernard, Verhoye Jean Philippe, Abi-Akar Ramzi, Achouh Paul, Cuisset Thomas, Leprince Pascal, Marijon Eloi, Le Breton Hervé, Lafont Antoine
Аннотация
OBJECTIVES: This study compared nonfemoral peripheral (n-FP) TAVR with femoral TAVR.
METHODS: Using the data from the national prospective French registry (FRANCE TAVI [French Transcatheter Aortic Valve Implantation]), this study compared the characteristics and outcomes of TAVR procedures according to whether they were performed through a femoral or a n-FP access, using a pre-specified propensity score-based matching between groups. Subanalysis during 2 study periods (2013 to 2015 and 2016 to 2017) and among low/intermediate-low and intermediate-high/high volume centers were performed.
RESULTS: Among 21,611 patients, 19,995 (92.5%) underwent femoral TAVR and 1,616 (7.5%) underwent n-FP TAVR (transcarotid, n = 914 or trans-subclavian, n = 702). Patients in the n-FP access group had more severe disease (mean logistic EuroSCORE 19.95 vs. 16.95; p < 0.001), with a higher rate of peripheral vascular disease, known coronary artery disease, chronic pulmonary disease, and renal failure. After matching, there was no difference in the rate of post-procedural death and complications according to access site, except for a 2-fold lower rate of major vascular complications (odds ratio: 0.45; 95% confidence interval: 0.21 to 0.93; p = 0.032) and unplanned vascular repairs (odds ratio: 0.41; 95% confidence interval: 0.29 to 0.59; p < 0.001) in those who underwent n-FP access. The comparison of outcomes provided similar results during the second study period and in intermediate-high/high volume centers.
CONCLUSIONS: n-FP TAVR is associated with similar outcomes compared with femoral peripheral TAVR, except for a 2-fold lower rate of major vascular complications and unplanned vascular repairs. n-FP TAVR may be favored over surgery in patients who are deemed ineligible for femoral TAVR and may be a safe alternative when femoral access risk is considered too high.