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Femoral Versus Nonfemoral Peripheral Access for Transcatheter Aortic Valve Replacement.

Authors
  • Beurtheret, Sylvain1
  • Karam, Nicole2
  • Resseguier, Noemie3
  • Houel, Remi4
  • Modine, Thomas5
  • Folliguet, Thierry6
  • Chamandi, Chekrallah7
  • Com, Olivier8
  • Gelisse, Richard8
  • Bille, Jacques8
  • Joly, Patrick8
  • Barra, Nicolas8
  • Tavildari, Alain8
  • Commeau, Philippe9
  • Armero, Sebastien10
  • Pankert, Mathieu11
  • Pansieri, Michel11
  • Siame, Sabrina4
  • Koning, René12
  • Laskar, Marc13
  • And 20 more
  • 1 Cardiac Surgery Department, Saint Joseph Hospital, Marseille France. Electronic address: [email protected] , (France)
  • 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. , (France)
  • 3 Department of Biostatistics and Public Health, La Timone Hospital, Marseille, France. , (France)
  • 4 Cardiac Surgery Department, Saint Joseph Hospital, Marseille France. , (France)
  • 5 Cardiac Surgery Department, Cardiologic University Hospital, Lille, France. , (France)
  • 6 Department of Cardiothoracic Surgery and Transplantation, University of Lorraine, Centre Hospitalier Universitaire Brabois, Vandoeuvre les Nancy, France. , (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. , (France)
  • 8 Cardiology Department, Saint Joseph Hospital, Marseille, France. , (France)
  • 9 Department of Cardiology, Clinique des Fleurs Ollioules, Ollioules, France. , (France)
  • 10 Department of Cardiology, Hôpital Européen, Marseille, France. , (France)
  • 11 Department of Cardiology, Centre Hospitalier Henri Duffaut, Avignon, France. , (France)
  • 12 Cardiology Service, Saint Hilaire Clinic, Rouen, France. , (France)
  • 13 Department of Cardiac Surgery, Centre Hospitalier Dupuytren, Limoges, France. , (France)
  • 14 Paris South Cardio-vascular Institute, Jacques-Cartier Private Hospital, Massy, France. , (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. , (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. , (France)
  • 17 Cardiology Service, Rouen-Charles-Nicolle University Hospital Centre, National Institute of Health and Medical Research U644, Rouen, France. , (France)
  • 18 Department of Cardiology, University Hospital Department Fire and Paris-Diderot University, Public Assistance Hospitals of Paris, Bichat Hospital, Paris, France. , (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. , (France)
  • 20 Cardiac Surgery Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France. , (France)
  • 21 Cardiology Department, La Timone Hospital, Marseille, France. , (France)
  • 22 Cardiac Surgery Department, Sorbonne-Pierre-et-Marie-Curie University, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier de la Pitié Salpêtrière, Paris, France. , (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. , (France)
  • 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. , (France)
Type
Published Article
Journal
Journal of the American College of Cardiology
Publication Date
Dec 03, 2019
Volume
74
Issue
22
Pages
2728–2739
Identifiers
DOI: 10.1016/j.jacc.2019.09.054
PMID: 31779788
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. This study compared nonfemoral peripheral (n-FP) TAVR with femoral TAVR. 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. 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. 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. Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

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