Comparison of Outcomes Following Transcatheter Aortic Valve Replacement Requiring Peripheral Vascular Intervention or Alternative Access

Abstract

Background Peripheral vascular intervention (PVI) is occasionally required to facilitate delivery system insertion or to treat vascular complications during transfemoral transcatheter aortic valve replacement (TF‐TAVR). However, the impact of PVI on outcomes is not well understood. Therefore, we aimed to compare outcomes between TF‐TAVR with versus without PVI and between TF‐TAVR with PVI versus non‐TF‐TAVR. Methods and Results We retrospectively reviewed 2386 patients who underwent TAVR with a balloon‐expandable valve at a single institution from 2016 to 2020. The primary outcomes were death and major adverse cardiac/cerebrovascular event (MACCE), defined as death, myocardial infarction, or stroke. Of 2246 TF‐TAVR recipients, 136 (6.1%) required PVI (89% bailout treatment). During follow‐up (median 23.0 months), there were no significant differences between TF‐TAVR with and without PVI in death (15.4% versus 20.7%; adjusted HR [aHR], 0.96 [95% CI, 0.58–1.58]) or MACCE (16.9% versus 23.0%; aHR, 0.84 [95% CI, 0.52–1.36]). However, compared with non‐TF‐TAVR (n=140), TF‐TAVR with PVI carried significantly lower rates of death (15.4% versus 40.7%; aHR, 0.42 [95% CI, 0.24–0.75]) and MACCE (16.9% versus 45.0%; aHR, 0.40 [95% CI, 0.23–0.68]). Landmark analyses demonstrated lower outcome rates following TF‐TAVR with PVI than non‐TF‐TAVR both within 60 days (death 0.7% versus 5.7%, P =0.019; MACCE 0.7% versus 9.3%; P =0.001) and thereafter (death 15.0% versus 38.9%, P =0.014; MACCE 16.5% versus 41.3%, P =0.013). Conclusions The need for PVI during TF‐TAVR is not uncommon, mainly due to the bailout treatment for vascular complications. PVI is not associated with worse outcomes in TF‐TAVR recipients. Even when PVI is required, TF‐TAVR is associated with better short‐ and intermediate‐term outcomes than non‐TF‐TAVR.

Time From First Contact With Heart Team to Transcatheter Aortic Valve Replacement in the COVID-19 Era

“…This study serves to highlight the known problem in providing care to patients with aortic stenosis: the increased time interval from diagnosis to TAVR results in greater mortality, increased hospitalization rates, and worsening functional status and quality of life [7,8]. Additionally, this study presents evidence for the critical need for timely intervention and streamlined patient care pathways for patients diagnosed with aortic stenosis [2,3]. More specifically in this study, we demonstrate the challenges of the COVID-19 pandemic across a single health system, including a significantly increased time to TAVR across Wave 1 and Wave 2 (the study's primary outcome) and a significant increase in all-cause PO mortality across all COVID waves compared to pre-COVID time points (the study's secondary outcome).…”

“…Transcatheter aortic valve replacement (TAVR) has become the dominant form of aortic valve replacement over the past decade for patients with aortic stenosis [1][2][3][4]. Previously, surgical aortic valve replacement (SAVR) was the treatment of choice for the majority of patients except for those at extreme risk [2][3][4][5]. Since 2019, TAVR has been extended to a much larger patient population, including those at low risk [4,5].…”