Secondary access and routine protection wire for transfemoral transcatheter aortic valve replacement: the SURF-TAVR registry.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Cozzi Ottavia, Ratan Prem, Costa Giulia, Branca Luca, Boiago Mauro, Fezzi Simone, Biroli Matteo, Munafò Andrea, Montalto Claudio, Colombo Francesco, Gallo Francesco, Pellegrini Dario, Casenghi Matteo, Giacomin Enrico, Regazzoli Damiano, Sticchi Alessandro, De Biase Chiara, Chiarito Mauro, De Carlo Marco, Adamo Marianna, Tchètchè Didier, Cernetti Carlo, Barbato Emanuele, Ielasi Alfonso, Tumminello Gabriele, Azzano Alessia, Brscic Elvis, Vercellino Matteo, Busco Marco, Maffeo Diego, Barbierato Marco, Boccuzzi Giacomo G, Ribichini Flavio, De Marco Federico, Oreglia Jacopo, Stefanini Giulio, Reimers Bernhard, Mangieri Antonio
Аннотация
OBJECTIVES: This study assessed the impact of RP on vascular complications in a contemporary TF-TAVR cohort.
METHODS: The SURF-TAVR registry analyzed 4224 TF-TAVR patients treated between January 2020 and August 2023 at 15 centers in Italy and France. Patients were categorized into RP or no-routine protection (nRP) centers. Propensity score matching (PSM) adjusted for baseline differences. The primary endpoint was overall vascular complications (VARC-3 criteria). Secondary outcomes included major vascular complications, bleeding, acute kidney injury, and intrahospital mortality.
RESULTS: Of the analyzed patients, 69.1% were treated in nRP centers and 30.9% in RP centers. Secondary access was predominantly transradial in the nRP group (82%) and contralateral femoral in the RP group (87.5%). nRP was associated with fewer overall vascular complications (8.3% vs. 12.1%, p < 0.001), but more major vascular complications (2.4% vs. 1.1%, p = 0.009). Bleeding rates were lower with nRP (6.6% vs. 9.7%, p < 0.001), while major bleedings were comparable (3.8% vs 4.8%, p = 0.111). Propensity score matching confirmed these findings.
CONCLUSIONS: Routine wire protection in transfemoral TAVR is associated with increased overall vascular complications and bleeding, but appears to lower the risk of major vascular complications. These findings underscore the need to carefully weigh procedural risks and benefits to optimize vascular access management in TF-TAVR.