Peripheral Access Associated With Favorable Mortality Outcomes, Higher Stroke Risk vs. Central Access in TAVR: NCDR Study

When looking at outcomes with alternative access routes for TAVR, peripheral access was found to have a significantly lower all-cause mortality rate but higher risk of stroke compared with central access, according to a recent study published in Circulation: Cardiovascular Interventions.

Tsuyoshi Kaneko, MD, et al., used data from the STS/ACC TVT Registry to identify patients in whom alternative access was used for TAVR from June 1, 2015 to June 30, 2018. Of the 7,187 patients in this cohort, peripheral access was used in 52% and central access in 48%.

Results showed that all-cause mortality was significantly lower with peripheral access vs. central access, both in-hospital (2.9% vs. 6.3%) and at one year post procedure (20.3% vs. 26.6%). Despite the lower mortality rate, the likelihood of stroke was found to be higher for peripheral access procedures both in at-hospital (5.0% vs. 2.8%) and after one year (7.3% vs. 5.5%; p<0.001). Adjusted rates after one year were similar, with an adjusted hazard ratio of 0.72 for all-cause mortality and 2.92 for stroke.

Notably, by subtypes, mortality was higher and stroke was lower with transapical and transaortic access, compared with transaxillary/subclavian access.

Kaneko, et al., note that patient anatomy must ultimately decide which access approach is best, and state "although these data provide useful guidance on the relative safety and efficacy of peripheral versus central approaches, further efforts to reduce stroke are warranted in the context of transaxillary/subclavian access." Furthermore, "these findings may allow for accurate prognostication of risk for patient counseling and decision-making for the heart team with regard to alternative access TAVR."

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: STS/ACC TVT Registry, National Cardiovascular Data Registries, Transcatheter Aortic Valve Replacement, Registries, Proportional Hazards Models, Counseling, Aortic Valve Stenosis

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