Quebec Heart & Lung Institute, Laval University, Quebec City, Canada.
Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain.
Interact Cardiovasc Thorac Surg. 2022 Jun 1;34(6):982-989. doi: 10.1093/icvts/ivab354.
Obesity may increase the risk of vascular complications in transfemoral (TF) transcatheter aortic valve replacement (TAVR) procedures. The transcarotid (TC) approach has recently emerged as an alternative access in TAVR. We sought to compare vascular complications and early clinical outcomes in obese patients undergoing TAVR either by TF or TC vascular access.
Multicentre registry including obese patients undergoing TF- or TC-TAVR in 15 tertiary centres. All patients received newer-generation transcatheter heart valves. For patients exhibiting unfavourable ileo-femoral anatomic characteristics, the TC approach was favoured in 3 centres with experience with it. A propensity score analysis was performed for overcoming unbalanced baseline covariates. The primary end point was the occurrence of in-hospital vascular complications (Valve Academic Research Consortium-2 criteria).
A total of 539 patients were included, 454 (84.2%) and 85 (15.8%) had a TF and TC access, respectively. In the propensity-adjusted cohort (TF: 442 patients; TC: 85 patients), both baseline and procedural valve-related characteristics were well-balanced between groups. A significant decrease in vascular complications was observed in the TC group (3.5% vs 12% in the TF group, odds ratio: 0.26, 95% CI: 0.07-0.95, P = 0.037). There were no statistically significant differences between groups regarding in-hospital mortality (TC: 2.8%, TF: 1.5%), stroke (TC: 1.2%, TF: 0.4%) and life-threatening/major bleeding events (TC: 2.8%, TF: 3.8%).
In patients with obesity undergoing TAVR with newer-generation devices, the TC access was associated with a lower rate of vascular complications. Larger randomized studies are warranted to further assess the better approach for TAVR in obese patients.
肥胖可能增加经股（TF）经导管主动脉瓣置换术（TAVR）血管并发症的风险。经颈动脉（TC）入路最近已成为 TAVR 的另一种入路选择。我们旨在比较肥胖患者行经 TF 或 TC 血管入路 TAVR 的血管并发症和早期临床结局。
该多中心注册研究纳入了在 15 家三级中心行经 TF 或 TC-TAVR 的肥胖患者。所有患者均接受了新一代经导管心脏瓣膜。对于存在不利的髂股解剖特征的患者，如果 3 家中心有经 TC 入路的经验，则倾向于选择 TC 入路。采用倾向评分分析来克服不平衡的基线协变量。主要终点是住院期间血管并发症的发生（瓣膜学术研究联合会-2 标准）。
共纳入 539 例患者，其中 454 例（84.2%）和 85 例（15.8%）分别采用 TF 和 TC 入路。在倾向评分调整后的队列中（TF：442 例；TC：85 例），两组的基线和手术相关瓣膜特征均得到很好的平衡。TC 组血管并发症显著减少（3.5%比 TF 组的 12%，比值比：0.26，95%置信区间：0.07-0.95，P=0.037）。两组之间在住院期间死亡率（TC：2.8%，TF：1.5%）、卒中和危及生命/主要出血事件（TC：2.8%，TF：3.8%）方面无统计学差异。
在接受新一代器械进行 TAVR 的肥胖患者中，TC 入路与较低的血管并发症发生率相关。需要更大规模的随机研究来进一步评估肥胖患者 TAVR 的更佳方法。
