1. Clinical Impact of Crossover Techniques for Primary Access Hemostasis in Transfemoral Transcatheter Aortic Valve Replacement Procedures
- Author
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Junquera, Lucia, Urena, Marina, Latib, Azeem, Munoz-Garcia, Antonio, Nombela-Franco, Luis, Faurie, Benjamin, Alperi, Alberto, Serra, Vicenc, Regueiro, Ander, Fisher, Quentin, Himbert, Dominique, Mangieri, Antonio, antonio colombo, Munoz Garcia, Erika, Vera Urquiza, Rafael, Jimenez-Quevedo, Pilar, Pascual, Isaac, Garcia Del Blanco, Bruno, Sabate, Manel, Mohammadi, Siamak, Freitas-Ferraz, Afonso B., Muntane-Carol, Guillem, Couture, Thomas, Paradis, Jean-Michel, Cote, Melanie, and Rodes-Cabau, Josep
- Subjects
Femoral Artery ,Transcatheter Aortic Valve Replacement ,Hemostasis ,Treatment Outcome ,Risk Factors ,Humans ,Aortic Valve Stenosis - Abstract
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).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.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.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).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.
- Published
- 2021