Clinical Impact of Crossover Techniques for Primary Access Hemostasis in Transfemoral Transcatheter Aortic Valve Replacement Procedures.

Abstract

OBJECTIVES:

To determine the occurrence of vascular complications (VCs) following transfemoral transcatheter aortic valve replacement (TAVR) with new-generation devices according to the use of a crossover technique (COT).

BACKGROUND:

The use of a COT (with/without balloon) has been associated with a reduction of VCs in TAVR patients. However, scarce data support its use with second-generation devices. Also, its potential benefit in obese patients (at high-risk of VCs) has not been elucidated.

METHODS:

A multicenter study including 2214 patients who underwent full percutaneous transfemoral TAVR (COT, 1522 patients; no COT, 692 patients). Thirty-day events were evaluated according to the use of a COT using a multivariate logistic regression model. A subanalysis was performed in obese patients.

RESULTS:

Primary access major VCs (3.5% COT vs 3.9% no COT; P=.19), major/life-threatening bleeding (3.4% COT vs 2.0% no COT; P=.33), and mortality rates (2.4% COT vs 2.6% no COT; P=.23) were similar between groups. However, minor VCs (11.7% COT vs 5.9% no COT; P<.001) and postprocedural acute renal failure (8.9% COT vs 3.9% no COT; P<.001) were higher in patients undergoing the COT. In the overall cohort, percutaneous closure device failure was more frequent in obese patients (4.0% in the obese group vs 1.9% in the non-obese group; P<.01), but these differences were no longer significant in those undergoing a COT (3.4% in the obese group vs 2.0% in the non-obese group; P=.12). Indeed, in the subset of obese patients, the COT tended to be associated with fewer VCs (3.4% COT vs 5.9% no COT; P=.09).

CONCLUSIONS:

The use of a COT was not associated with a reduction of major VCs or improved outcomes. However, some patient subsets, such as those with higher body mass index, may benefit from the use of a COT. These findings would suggest the application of a tailored strategy, following a risk-benefit assessment in each TAVR candidate.

• Authors: Lucía Junquera, Marina Urena, Azeem Latib, Antonio Muñoz-Garcia, Luis Nombela-Franco, Benjamin Faurie, Alberto Alperi, Vicenç Serra, Ander Regueiro, Quentin Fisher, Dominique Himbert, Antonio Mangieri, Antonio Colombo, Erika Muñoz García, Rafael Vera Urquiza, Pilar Jiménez-Quevedo, Isaac Pascual, Bruno Garcia Del Blanco, Manel Sabaté, Siamak Mohammadi, Afonso B Freitas-Ferraz, Guillem Muntané-Carol, Thomas Couture, Jean-Michel Paradis, Melanie Côté, Josep Rodés-Cabau
• Journal: The Journal of invasive cardiology (J Invasive Cardiol) Vol. 33 Issue 4 Pg. E302-E311 (04 2021) ISSN: 1557-2501 [Electronic] United States
• PMID: 33600353 (Publication Type: Journal Article, Multicenter Study)

Topics

• Aortic Valve Stenosis (diagnosis, surgery)
• Femoral Artery (surgery)
• Hemostasis
• Humans
• Risk Factors
• Transcatheter Aortic Valve Replacement (adverse effects)
• Treatment Outcome