Sylvain Beurtheret1, Nicole Karam2, Noemie Resseguier3, Remi Houel4, Thomas Modine5, Thierry Folliguet6, Chekrallah Chamandi7, Olivier Com8, Richard Gelisse8, Jacques Bille8, Patrick Joly8, Nicolas Barra8, Alain Tavildari8, Philippe Commeau9, Sebastien Armero10, Mathieu Pankert11, Michel Pansieri11, Sabrina Siame4, René Koning12, Marc Laskar13, Yvan Le Dolley4, Arnaud Maudiere4, Bertrand Villette4, Patrick Khanoyan8, Julien Seitz8, Didier Blanchard7, Christian Spaulding7, Thierry Lefevre14, Eric Van Belle15, Martine Gilard16, Helene Eltchaninoff17, Bernard Iung18, Jean Philippe Verhoye19, Ramzi Abi-Akar20, Paul Achouh20, Thomas Cuisset21, Pascal Leprince22, Eloi Marijon23, Hervé Le Breton24, Antoine Lafont7. 1. Cardiac Surgery Department, Saint Joseph Hospital, Marseille France. Electronic address: sbeurtheret@hopital-saint-joseph.fr. 2. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France. Electronic address: https://twitter.com/nickaram. 3. Department of Biostatistics and Public Health, La Timone Hospital, Marseille, France. 4. Cardiac Surgery Department, Saint Joseph Hospital, Marseille France. 5. Cardiac Surgery Department, Cardiologic University Hospital, Lille, France. 6. Department of Cardiothoracic Surgery and Transplantation, University of Lorraine, Centre Hospitalier Universitaire Brabois, Vandoeuvre les Nancy, France. 7. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France. 8. Cardiology Department, Saint Joseph Hospital, Marseille, France. 9. Department of Cardiology, Clinique des Fleurs Ollioules, Ollioules, France. 10. Department of Cardiology, Hôpital Européen, Marseille, France. 11. Department of Cardiology, Centre Hospitalier Henri Duffaut, Avignon, France. 12. Cardiology Service, Saint Hilaire Clinic, Rouen, France. 13. Department of Cardiac Surgery, Centre Hospitalier Dupuytren, Limoges, France. 14. Paris South Cardio-vascular Institute, Jacques-Cartier Private Hospital, Massy, France. 15. Department of Cardiology, University of Lille 2, Regional University Hospital Centre of Lille, National Institute of Health and Medical Research U1011, University Hospital Federation Integra, Lille, France. 16. Department of Cardiology, La Cavale Blanche University Hospital Centre, Optimization of Physiological Regulations, Science and Technical Training And Research Unit, University of Western Brittany, Brest, France. 17. Cardiology Service, Rouen-Charles-Nicolle University Hospital Centre, National Institute of Health and Medical Research U644, Rouen, France. 18. Department of Cardiology, University Hospital Department Fire and Paris-Diderot University, Public Assistance Hospitals of Paris, Bichat Hospital, Paris, France. 19. Thoracic and Cardiovascular Surgery Service, Pontchaillou University Hospital Centre, University of Rennes 1, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France. 20. Cardiac Surgery Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France. 21. Cardiology Department, La Timone Hospital, Marseille, France. 22. Cardiac Surgery Department, Sorbonne-Pierre-et-Marie-Curie University, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier de la Pitié Salpêtrière, Paris, France. 23. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France. Electronic address: https://twitter.com/EloiMarijon. 24. Cardiology and Vascular Diseases Service, Pontchaillou University Hospital Centre, Centre for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment Laboratory, National Institute of Health and Medical Research U1099, Rennes, France.
Abstract
BACKGROUND: Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Guidelines recommend reconsidering surgery when this access is not feasible. However, alternative peripheral accesses exist, although they have not been accurately compared with femoral access. 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.
BACKGROUND: Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Guidelines recommend reconsidering surgery when this access is not feasible. However, alternative peripheral accesses exist, although they have not been accurately compared with femoral access. 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.
Authors: Seok Oh; Ju Han Kim; Dae Young Hyun; Kyung Hoon Cho; Min Chul Kim; Doo Sun Sim; Young Joon Hong; Youngkeun Ahn; Myung Ho Jeong; Kyo Seon Lee Journal: Medicine (Baltimore) Date: 2021-10-01 Impact factor: 1.889
Authors: Alfredo Intorcia; Vittorio Ambrosini; Michele Capasso; Riccardo Granata; Fabio Magliulo; Giannignazio Luigi Carbone; Stefano Capobianco; Francesco Rotondi; Francesca Lanni; Fiore Manganelli; Emilio Di Lorenzo Journal: Int J Environ Res Public Health Date: 2022-04-14 Impact factor: 3.390