Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR: The Hostile Registry |
| |
| Affiliation: | 1. Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy;2. Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy;3. Kerckhoff Heart Center, Bad Nauheim, Germany;4. UOSA Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy;5. Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;6. U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy;7. Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands;8. Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;9. A.O. Mauriziano Umberto I Hospital, Turin, Italy;10. Klinik III für Innere Medizin - Kardiologie, Pneumologie und Internistische Intensivmedizin, University Hospital Cologne – Heart Center, Cologne, Germany;11. German Heart Centre Munich, Munich, Germany;12. Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Institutio Mexicano de Seguro Social, Mexico City, Mexico;13. University Hospital Careggi, Florence, Italy;14. Cardiology, Heart Center Lucerne, Lucerne, Switzerland;15. Vascular Surgery, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy;p. Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy;q. Unit of Diagnostic and Interventional Cardiology, C.N.R. Reg. Toscana G. Monasterio Foundation, Ospedale del Cuore, Massa, Italy;r. Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;s. Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy;t. Department of Medicine I, University Hospital Munich, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany;u. Cardioangiology Cath Lab, Cotignola, Italy;v. Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy;w. Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy;x. Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy;y. Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany;z. Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I – GM Lancisi, Torette, Italy;11. Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA;22. Cardiovascular Research Foundation, New York, New York, USA;33. Cardiology Unit, Cardio-Thoraco Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;44. Rabin Medical Center, Petah Tikva, Israel;55. Centro Cardiologico Monzino, Milan, Italy;66. Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy;77. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy;88. Heart Center Leipzig, University of Leipzig, Leipzig, Germany;99. Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA |
| |
| Abstract: | BackgroundThe optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined.ObjectivesThis study sought to compare clinical outcomes with transfemoral access (TFA), transthoracic access (TTA), and nonthoracic transalternative access (TAA) in TAVR patients with severe PAD.MethodsPatients 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).ResultsAmong 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).ConclusionsAmong 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. |
| |
| Keywords: | alternative access critical patient femoral access transcatheter aortic valve replacement MAE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" major adverse event(s) PAD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" peripheral artery disease PTA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" percutaneous transluminal angioplasty TAA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" transalternative access TAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" transcatheter aortic valve replacement TFA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" transfemoral access TIA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" transient ischemic attack TTA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" transthoracic access VARC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" Valve Academic Research Consortium |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
