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.).
Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (M.U., Q.F., D.H.).
Circ Cardiovasc Interv. 2020 Mar;13(3):e008609. doi: 10.1161/CIRCINTERVENTIONS.119.008609. Epub 2020 Feb 24.
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.
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.
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%, <0.001; major VC, 1.6% versus 0%, <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%, <0.001; major VC, 1.8% versus 0%, <0.001), which also exhibited a higher rate of major/life-threatening bleeding events (1.0% versus 0%, <0.001). Significant differences between secondary access groups were observed regarding the rates of 30-day stroke (transfemoral: 3.1%, transradial: 1.6%; =0.043), acute kidney injury (transfemoral: 9.9%, transradial: 5.7%; <0.001), and mortality (transfemoral: 4.0%, transradial: 2.4%, =0.047).
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.
经股动脉入路已被广泛应用于经导管主动脉瓣置换术（TAVR）的二次入路。经桡动脉入路作为 TAVR 手术的二次入路的使用情况和潜在临床获益的数据较为匮乏。本研究旨在评估经股动脉与经桡动脉入路作为 TAVR 术后二次入路时血管并发症（VC）和临床结局的发生情况。
这是一项多中心研究，共纳入 4949 名接受 TAVR 治疗的患者（平均年龄 81±8 岁，平均胸外科医师协会评分 4.9[3.3-7.5]）。4016 名（81.1%）和 933 名（18.9%）患者分别采用经股动脉和经桡动脉入路作为二次入路。根据 Valve Academic Research Consortium-2 标准评估并定义 30 天内临床事件（血管和出血并发症、卒中和急性肾损伤以及死亡率）。在总人群中以及涉及 2978 例经股动脉和 928 例经桡动脉患者的倾向评分匹配人群中，根据二次入路（经股动脉与经桡动脉）分析临床结局。
共有 834 名（16.9%）患者发生相关入路 VC（主要 VC，5.7%），其中 172 名（3.5%）患者的 VC 与二次入路相关（主要 VC，1.3%）。经股动脉组的 VC 相关二次入路发生率更高（VC，4.1%比 0.9%，<0.001；主要 VC，1.6%比 0%，<0.001）。在倾向评分匹配人群中，经股动脉组的 VC 相关二次入路发生率仍更高（VC，4.7%比 0.9%，<0.001；主要 VC，1.8%比 0%，<0.001），且主要/危及生命的出血事件发生率也更高（1.0%比 0%，<0.001）。在 30 天卒中和死亡率方面，经股动脉组与经桡动脉组之间存在显著差异（经股动脉：3.1%，经桡动脉：1.6%；=0.043）；经股动脉组与经桡动脉组之间的急性肾损伤发生率差异也有统计学意义（经股动脉：9.9%，经桡动脉：5.7%；<0.001）。
TAVR 手术中采用经桡动脉入路作为二次入路与血管和出血并发症显著减少以及 30 天结局改善相关。未来需要进行随机研究。
