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Background <p>Vascular complications remain a challenge in transfemoral transcatheter aortic valve replacement (TF-TAVR). Evidence for routine wire protection (RP) to mitigate these complications is limited.</p> Objectives <p>This study assessed the impact of RP on vascular complications in a contemporary TF-TAVR cohort.</p> Methods <p>The SURF-TAVR registry analyzed 4224 TF-TAVR patients treated between January 2020 and August 2023 at 15 centers in Italy and France. Patients were categorized into RP or no-routine protection (nRP) centers. Propensity score matching (PSM) adjusted for baseline differences. The primary endpoint was overall vascular complications (VARC-3 criteria). Secondary outcomes included major vascular complications, bleeding, acute kidney injury, and intrahospital mortality.</p> Results <p>Of the analyzed patients, 69.1% were treated in nRP centers and 30.9% in RP centers. Secondary access was predominantly transradial in the nRP group (82%) and contralateral femoral in the RP group (87.5%). nRP was associated with fewer overall vascular complications (8.3% vs. 12.1%, <i>p</i> &lt; 0.001), but more major vascular complications (2.4% vs. 1.1%, <i>p</i> = 0.009). Bleeding rates were lower with nRP (6.6% vs. 9.7%, <i>p</i> &lt; 0.001), while major bleedings were comparable (3.8% vs 4.8%, <i>p</i> = 0.111). Propensity score matching confirmed these findings.</p> Conclusions <p>Routine wire protection in transfemoral TAVR is associated with increased overall vascular complications and bleeding, but appears to lower the risk of major vascular complications. These findings underscore the need to carefully weigh procedural risks and benefits to optimize vascular access management in TF-TAVR.</p> Graphical Abstract <p>(Top) Study flow-chart. (Bottom left) Preferred secondary access used in the two populations and overall rates for the primary outcomes and odds ratios for the key clinical outcomes for the routine protection wire technique. (Bottom right) Bar graph showing the rates of vascular complications and bleedings in the two groups. nRP = no-routine protection wire, ns= notsignificant,&#xa0;OR = odds ratio, PSM = propensity score matching, RP = routine protection wire, TF-TAVR = transfemoral-transcatheter aortic valve replacement, VARC-3 = Valve Academic Research Consortium-3 * = <i>p</i> value &lt; 0.05</p> <p></p>

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Secondary access and routine protection wire for transfemoral transcatheter aortic valve replacement: the SURF-TAVR registry

  • 期刊论文

  • 发表日期：

    2025年10月20日

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  • Ottavia Cozzi,
  • Prem Ratan,
  • Giulia Costa,
  • Luca Branca,
  • Mauro Boiago,
  • Simone Fezzi,
  • Matteo Biroli,
  • Andrea Munafò,
  • Claudio Montalto,
  • Francesco Colombo,
  • Francesco Gallo,
  • Dario Pellegrini,
  • Matteo Casenghi,
  • Enrico Giacomin,
  • Damiano Regazzoli,
  • Alessandro Sticchi,
  • Chiara De Biase,
  • Mauro Chiarito,
  • Marco De Carlo,
  • Marianna Adamo,
  • Didier Tchètchè,
  • Carlo Cernetti,
  • Emanuele Barbato,
  • Alfonso Ielasi,
  • Gabriele Tumminello,
  • Alessia Azzano,
  • Elvis Brscic,
  • Matteo Vercellino,
  • Marco Busco,
  • Diego Maffeo,
  • Marco Barbierato,
  • Giacomo G. Boccuzzi,
  • Flavio Ribichini,
  • Federico De Marco,
  • Jacopo Oreglia,
  • Giulio Stefanini,
  • Bernhard Reimers,
  • Antonio Mangieri

摘要

Background

Vascular complications remain a challenge in transfemoral transcatheter aortic valve replacement (TF-TAVR). Evidence for routine wire protection (RP) to mitigate these complications is limited.

Objectives

This study assessed the impact of RP on vascular complications in a contemporary TF-TAVR cohort.

Methods

The SURF-TAVR registry analyzed 4224 TF-TAVR patients treated between January 2020 and August 2023 at 15 centers in Italy and France. Patients were categorized into RP or no-routine protection (nRP) centers. Propensity score matching (PSM) adjusted for baseline differences. The primary endpoint was overall vascular complications (VARC-3 criteria). Secondary outcomes included major vascular complications, bleeding, acute kidney injury, and intrahospital mortality.

Results

Of the analyzed patients, 69.1% were treated in nRP centers and 30.9% in RP centers. Secondary access was predominantly transradial in the nRP group (82%) and contralateral femoral in the RP group (87.5%). nRP was associated with fewer overall vascular complications (8.3% vs. 12.1%, p < 0.001), but more major vascular complications (2.4% vs. 1.1%, p = 0.009). Bleeding rates were lower with nRP (6.6% vs. 9.7%, p < 0.001), while major bleedings were comparable (3.8% vs 4.8%, p = 0.111). Propensity score matching confirmed these findings.

Conclusions

Routine wire protection in transfemoral TAVR is associated with increased overall vascular complications and bleeding, but appears to lower the risk of major vascular complications. These findings underscore the need to carefully weigh procedural risks and benefits to optimize vascular access management in TF-TAVR.

Graphical Abstract

(Top) Study flow-chart. (Bottom left) Preferred secondary access used in the two populations and overall rates for the primary outcomes and odds ratios for the key clinical outcomes for the routine protection wire technique. (Bottom right) Bar graph showing the rates of vascular complications and bleedings in the two groups. nRP = no-routine protection wire, ns= notsignificant, OR = odds ratio, PSM = propensity score matching, RP = routine protection wire, TF-TAVR = transfemoral-transcatheter aortic valve replacement, VARC-3 = Valve Academic Research Consortium-3 * = p value < 0.05