Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR

被引：27

作者：

Palmerini, Tullio ^{[1
,2
,36
]}

Saia, Francesco ^{[1
,2
]}

Kim, Won-Keun ^{[3
]}

Renker, Matthias ^{[3
]}

Iadanza, Alessandro ^{[4
]}

Fineschi, Massimo ^{[4
]}

Bruno, Antonio Giulio ^{[1
,2
]}

Ghetti, Gabriele ^{[1
,2
]}

Vanhaverbeke, Maarten ^{[5
]}

Sondergaard, Lars ^{[5
]}

De Backer, Ole ^{[5
]}

Romagnoli, Enrico ^{[6
]}

Burzotta, Francesco ^{[1
,6
]}

Trani, Carlo ^{[1
,6
]}

Adrichem, Rik ^{[7
]}

Van Mieghem, Nicolas M. ^{[7
]}

Nardi, Elena ^{[1
]}

Chietera, Francesco ^{[1
,2
]}

Orzalkiewicz, Mateusz ^{[1
,2
]}

Tomii, Daijiro ^{[8
]}

Pilgrim, Thomas ^{[8
]}

Aranzulla, Tiziana Claudia ^{[9
]}

Musumeci, Giuseppe ^{[9
]}

Adam, Matti ^{[10
]}

Meertens, Max M. ^{[10
]}

Taglieri, Nevio ^{[1
,2
]}

Marrozzini, Cinzia ^{[1
,2
]}

Covarrubias, Hector Alfonso Alvarez ^{[11
,12
]}

Joner, Michael ^{[11
]}

Nardi, Giulia ^{[13
]}

Di Muro, Francesca Maria ^{[13
]}

Di Mario, Carlo ^{[13
]}

Loretz, Lucca ^{[14
]}

Toggweiler, Stefan ^{[14
]}

Gallitto, Enrico ^{[15
]}

Gargiulo, Mauro ^{[15
]}

Testa, Luca ^{[16
]}

Bedogni, Francesco ^{[16
]}

Berti, Sergio ^{[17
]}

Ancona, Marco B. ^{[18
]}

Montorfano, Matteo ^{[18
]}

Leone, Alessandro ^{[19
]}

Savini, Carlo ^{[19
]}

Pacini, Davide ^{[19
]}

Gmeiner, Jonas ^{[20
]}

Braun, Daniel ^{[20
]}

Nerla, Roberto ^{[21
]}

Castriota, Fausto ^{[21
]}

De Carlo, Marco ^{[22
]}

Petronio, Anna Sonia ^{[22
]}

机构：

[1] IRCCS Azienda Osped Univ Bologna, Cardiac Thorac & Vasc Dept, Cardiol Unit, Bologna, Italy

[2] Univ Bologna, Cardiac Thorac & Vasc Dept, Bologna, Italy

[3] Kerckhoff Heart Ctr, Bad Nauheim, Germany

[4] Azienda Osped Univ Senese, UOSA Cardiol Interventist, Siena, Italy

[5] Copenhagen Univ Hosp, Heart Ctr, Rigshosp, Copenhagen, Denmark

[6] Univ Cattolica Sacro Cuore, Fdn Policlin Univ Agostino Gemelli IRCCS, UOC Interventist Cardiol & Diagnost Invas, Rome, Italy

[7] Erasmus MC, Dept Cardiol, Thoraxctr, Rotterdam, Netherlands

[8] Univ Bern, Bern Univ Hosp, Inselspital, Bern, Switzerland

[9] AO Mauriziano Umberto I Hosp, Turin, Italy

[10] Univ Hosp Cologne, Heart Ctr, Klin Innere Med Kardiol Pneumol & Internist Intens, Cologne, Germany

[11] German Heart Ctr Munich, Munich, Germany

[12] Inst Mexicano Seguro Social, Hosp Cardiol, Ctr Med Nacl Siglo 21, Mexico City, Mexico

[13] Univ Hosp Careggi, Florence, Italy

[14] Heart Ctr Lucerne, Cardiol, Luzern, Switzerland

[15] IRCCS Azienda Osped Univ Bologna, Dipartimento Med Specialist Diagnost & Sperimental, Vasc Surg, Bologna, Italy

[16] IRCCS Policlin S Donato, Coronary Revascularisat Unit, San Donato Milanese, Italy

[17] Osped Cuore, Unit Diagnost & Intervent Cardiol, CNR Reg Toscana G Monasterio Fdn, Massa, Italy

[18] IRCCS San Raffaele Scienti f Inst, Intervent Cardiol Unit, Milan, Italy

[19] IRCCS Azienda Osped Univ Bologna, Cardiac Thorac & Vasc Dept, Cardiac Surg Unit, Bologna, Italy

[20] Ludwig Maximilian Univ Munich, Univ Hosp Munich, Med Fac, Dept Med 1, Munich, Germany

[21] Cardioangiol Cath Lab, Cotignola, Italy

[22] Pisa Univ Hosp, Cardiothorac & Vasc Dept, Pisa, Italy

[23] Univ Catania, Policlin Vittorio Emanuele Hosp, Div Cardiol, Catania, Italy

[24] Humanitas Res Hosp IRCCS, Cardio Ctr, Rozzano, Italy

[25] Univ Klinikum Bonn, Med Klin & Poliklin 2, Herzzentrum Bonn, Bonn, Germany

[26] Azienda Osped Univ, Osped Riuniti Umberto 1 GM Lancisi, Torette, Italy

[27] Albert Einstein Coll Med, Montefiore Med Ctr, Montefiore Einstein Ctr Heart & Vasc Care, Bronx, NY USA

[28] Cardiovasc Res Fdn, New York, NY USA

[29] IRCCS Osped Policlin San Martino, Cardiothoraco Vasc Dept, Cardiol Unit, Genoa, Italy

[30] Rabin Med Ctr, Petah Tiqwa, Israel

[31] Ctr Cardiol Monzino, Milan, Italy

[32] Univ Milan, Dept Biomed & Clin Sci, Milan, Italy

[33] Univ Padua, Dept Cardiac Thorac & Vasc Sci, Padua, Italy

[34] Univ Leipzig, Heart Ctr Leipzig, Leipzig, Germany

[35] Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY USA

[36] IRCCS Azienda Osped Univ Bologna, Via Massarenti 9, I-40138 Bologna, Italy

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2023年 / 16卷 / 04期

关键词：

alternative access; critical patient; femoral access; transcatheter aortic valve replacement; AORTIC-VALVE-REPLACEMENT; SUBCLAVIAN/AXILLARY ACCESS; ALTERNATIVE ACCESS; TVT REGISTRY; OUTCOMES; IMPLANTATION; STENOSIS;

D O I：

10.1016/j.jcin.2022.12.009

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined. 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 Con-sortium 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 1/4 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. (J Am Coll Cardiol Intv 2023;16:396-411) & COPY; 2023 by the American College of Cardiology Foundation.

引用

页码：396 / 411

页数：16

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