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Junquera L, Urena M, Latib A, Muñoz-Garcia A, Nombela-Franco L, Faurie B, Veiga-Fernandez G, Alperi A, Serra V, Regueiro A, Fischer Q, Himbert D, Mangieri A, Colombo A, Muñoz-García E, Vera-Urquiza R, Jiménez-Quevedo P, de la Torre JM, Pascual I, Garcia Del Blanco B, Sabaté M, Mohammadi S, Freitas-Ferraz AB, Guimarães L, Couture T, Côté M, Rodés-Cabau J. Comparison of Transfemoral Versus Transradial Secondary Access in Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008609. [PMID: 32089002 DOI: 10.1161/circinterventions.119.008609] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transfemoral approach has been commonly used as secondary access in transcatheter aortic valve replacement (TAVR). Scarce data exist on the use and potential clinical benefits of the transradial approach as secondary access during TAVR procedures. The objective of the study is to determine the occurrence of vascular complications (VC) and clinical outcomes according to secondary access (transfemoral versus transradial) in patients undergoing TAVR. METHODS This was a multicenter study including 4949 patients who underwent TAVR (mean age, 81±8 years, mean Society of Thoracic Surgeons score, 4.9 [3.3-7.5]). Transfemoral and transradial approaches were used as secondary access in 4016 (81.1%) and 933 (18.9%) patients, respectively. The 30-day clinical events (vascular and bleeding complications, stroke, acute kidney injury, and mortality) were evaluated and defined according to Valve Academic Research Consortium-2 criteria. Clinical outcomes were analyzed according to the secondary access (transfemoral versus transradial) in the overall population and in a propensity score-matched population involving 2978 transfemoral and 928 transradial patients. RESULTS Related-access VC occurred in 834 (16.9%) patients (major VC, 5.7%) and were related to the secondary access in 172 (3.5%) patients (major VC, 1.3%). The rate of VC related to the secondary access was higher in the transfemoral group (VC, 4.1% versus 0.9%, P<0.001; major VC, 1.6% versus 0%, P<0.001). In the propensity score-matched population, VC related to the secondary access remained higher in the transfemoral group (4.7% versus 0.9%, P<0.001; major VC, 1.8% versus 0%, P<0.001), which also exhibited a higher rate of major/life-threatening bleeding events (1.0% versus 0%, P<0.001). Significant differences between secondary access groups were observed regarding the rates of 30-day stroke (transfemoral: 3.1%, transradial: 1.6%; P=0.043), acute kidney injury (transfemoral: 9.9%, transradial: 5.7%; P<0.001), and mortality (transfemoral: 4.0%, transradial: 2.4%, P=0.047). CONCLUSIONS The use of transradial approach as secondary access in TAVR procedures was associated with a significant reduction in vascular and bleeding complications and improved 30-day outcomes. Future randomized studies are warranted.
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Affiliation(s)
- Lucía Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (M.U., Q.F., D.H.)
| | - Azeem Latib
- San Raffaele Scientific Institute, Milan, Italy (A.L., A.M., A.C.).,Montefiore Medical Center, New York, NY (A.L.)
| | | | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain (L.N.-F., R.V.U., P.J.-Q.)
| | - Benjamin Faurie
- Groupe Hospitalier Mutualiste de Grenoble, Institut Cardiovasculaire,Grenoble, France (B.F.)
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Spain (A.A., I.P.)
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., B.G.d.B.)
| | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (A.R., M.S.)
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (M.U., Q.F., D.H.)
| | - Dominique Himbert
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (M.U., Q.F., D.H.)
| | - Antonio Mangieri
- San Raffaele Scientific Institute, Milan, Italy (A.L., A.M., A.C.).,Maria Cecilia GVM Hospital, Cotignola, Italy (A.M., A.C.)
| | - Antonio Colombo
- San Raffaele Scientific Institute, Milan, Italy (A.L., A.M., A.C.).,Maria Cecilia GVM Hospital, Cotignola, Italy (A.M., A.C.)
| | - Erika Muñoz-García
- Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.M.-G., E.M.-G.)
| | - Rafael Vera-Urquiza
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain (L.N.-F., R.V.U., P.J.-Q.)
| | - Pilar Jiménez-Quevedo
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain (L.N.-F., R.V.U., P.J.-Q.)
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Spain (A.A., I.P.)
| | | | - Manel Sabaté
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (A.R., M.S.)
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Afonso B Freitas-Ferraz
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Leonardo Guimarães
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Thomas Couture
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Melanie Côté
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
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