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Outcomes of Intravascular Lithotripsy-Assisted Transfemoral TAVR
Quick Takes
- IVL TAVR was associated with a higher rate of the primary composite outcome driven by a higher rate of vascular complications, surgical vascular intervention, and major bleeding compared to non-IVL TAVR.
- The higher burden of comorbidities in the IVL TAVR group, as well as early operators’ learning curve, are likely the main reasons for the increased vascular-related adverse events.
- Additional studies are needed to determine the appropriate anatomical and clinical use criteria for IVL TAVR versus alternative access TAVR in patients with PAD.
Study Questions:
What are the contemporary characteristics, trends, and outcomes of intravascular lithotripsy (IVL)-assisted transfemoral (TF) transcatheter aortic valve replacement (TAVR) in the United States?
Methods:
The investigators queried Vizient Clinical Database for patients who underwent percutaneous TAVR between October 1, 2020, and November 30, 2023. Outcomes with IVL-TAVR versus non-IVL TAVR were examined after propensity score matching (PSM). The primary outcome was a composite of in-hospital death, stroke, vascular complications, surgical vascular intervention, and major bleeding.
Results:
Over the study period, 129,655 patients (mean age 78.4 years, 42.2% women, 87.1% White) underwent percutaneous TAVR at 361 hospitals, 1,242 (0.96%) of whom underwent IVL TAVR. There was an uptrend in IVL TAVR but frequency remained low. IVL TAVR patients had a higher median Elixhauser comorbidity score (5 [IQR 4, 7] vs. 4 [IQR 3, 6]) compared to non-IVL TAVR. TAVR was completed via the TF approach in 1,238 (99.7%) IVL TAVR patients. In a 3:1 PSM analysis, IVL TAVR was associated with a higher rate of the primary composite outcome (21.9% vs. 13.7%, p < 0.001), driven by higher rates of vascular complications, surgical vascular intervention, and major bleeding. In-hospital death and stroke were similar in both groups.
Conclusions:
The authors report that IVL TAVR patients exhibited a higher burden of comorbidities and experienced more complications compared to non-IVL TAVR patients.
Perspective:
This retrospective dataset study utilizing ICD codes reports that since its approval in late 2020, there has been an increase in the adoption of IVL to facilitate TF TAVR. IVL TAVR was associated with a higher rate of the primary composite outcome driven by a higher rate of vascular complications, surgical vascular intervention, and major bleeding compared to non-IVL TAVR. The higher burden of comorbidities in the IVL TAVR group, as well as early operators’ learning curve, are likely the main reasons for the increased vascular-related adverse events. Anatomical and clinical criteria that may be associated with improved outcomes with IVL-assisted TF TAVR versus alternative access TAVR remain unstudied, and additional studies are indicated to determine those criteria and guide-informed decisions in patients with iliofemoral peripheral artery disease (PAD).
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and Vascular Medicine, Vascular Medicine
Keywords: Lithotripsy, Peripheral Arterial Disease, Transcatheter Aortic Valve Replacement
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