Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR: The Hostile Registry.
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Palmerini Tullio, Saia Francesco, Kim Won-Keun, Renker Matthias, Iadanza Alessandro, Fineschi Massimo, Bruno Antonio Giulio, Ghetti Gabriele, Vanhaverbeke Maarten, Søndergaard Lars, De Backer Ole, Romagnoli Enrico, Burzotta Francesco, Trani Carlo, Adrichem Rik, Van Mieghem Nicolas M, Nardi Elena, Chietera Francesco, Orzalkiewicz Mateusz, Tomii Daijiro, Pilgrim Thomas, Aranzulla Tiziana Claudia, Musumeci Giuseppe, Adam Matti, Meertens Max M, Taglieri Nevio, Marrozzini Cinzia, Alvarez Covarrubias Hector Alfonso, Joner Michael, Nardi Giulia, Di Muro Francesca Maria, Di Mario Carlo, Loretz Lucca, Toggweiler Stefan, Gallitto Enrico, Gargiulo Mauro, Testa Luca, Bedogni Francesco, Berti Sergio, Ancona Marco B, Montorfano Matteo, Leone Alessandro, Savini Carlo, Pacini Davide, Gmeiner Jonas, Braun Daniel, Nerla Roberto, Castriota Fausto, De Carlo Marco, Petronio Anna Sonia, Barbanti Marco, Costa Giuliano, Tamburino Corrado, Leone Pier Pasquale, Reimers Bernhard, Stefanini Giulio, Sudo Mitsumasa, Nickenig Georg, Piva Tommaso, Scotti Andrea, Latib Azeem, Vercellino Matteo, Porto Italo, Codner Pablo, Kornowski Ran, Bartorelli Antonio L, Tarantini Giuseppe, Fraccaro Chiara, Abdel-Wahab Mohamed, Grube Eberhard, Galié Nazzareno, Stone Gregg W
Аннотация
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.