TY - JOUR
T1 - Clinical impact of crossover techniques for primary access hemostasis in transfemoral transcatheter aortic valve replacement procedures
AU - Junquera, Lucía
AU - Urena, Marina
AU - Latib, Azeem
AU - Muñoz-Garcia, Antonio
AU - Nombela-Franco, Luis
AU - Faurie, Benjamin
AU - Alperi, Alberto
AU - Serra, Vicenç
AU - Regueiro, Ander
AU - Fisher, Quentin
AU - Himbert, Dominique
AU - Mangieri, Antonio
AU - Colombo, Antonio
AU - García, Erika Muñoz
AU - Urquiza, Rafael Vera
AU - Jiménez-Quevedo, Pilar
AU - Pascual, Isaac
AU - del Blanco, Bruno Garcia
AU - Sabaté, Manel
AU - Mohammadi, Siamak
AU - Freitas-Ferraz, Afonso B.
AU - Muntané-Carol, Guillem
AU - Couture, Thomas
AU - Paradis, Jean Michel
AU - Côté, Melanie
AU - Rodés-Cabau, Josep
N1 - Publisher Copyright:
© 2021 HMP Communications. All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - Objectives. 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). Background. 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. Methods. 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. Results. 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). Conclusions. 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.
AB - Objectives. 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). Background. 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. Methods. 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. Results. 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). Conclusions. 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.
KW - Crossover technique
KW - Primary access hemostasis
KW - Transcatheter aortic valve replacement
KW - Vascular complications
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M3 - Article
C2 - 33600353
AN - SCOPUS:85103801597
SN - 1042-3931
VL - 33
SP - E302-E311
JO - Journal of Invasive Cardiology
JF - Journal of Invasive Cardiology
IS - 4
ER -