Femoral Versus Nonfemoral Peripheral Access for Transcatheter Aortic Valve Replacement

Sylvain Beurtheret; Nicole Karam; Noemie Resseguier; Remi Houel; Thomas Modine; Thierry Folliguet; Chekrallah Chamandi; Olivier Com; Richard Gelisse; Jacques Bille; Patrick Joly; Nicolas Barra; Alain Tavildari; Philippe Commeau; Sebastien Armero; Mathieu Pankert; Michel Pansieri; Sabrina Siame; René Koning; Marc Laskar; Yvan Le Dolley; Arnaud Maudiere; Bertrand Villette; Patrick Khanoyan; Julien Seitz; Didier Blanchard; Christian Spaulding; Thierry Lefevre; Eric Van Belle; Martine Gilard; Helene Eltchaninoff; Bernard Iung; Jean Philippe Verhoye; Ramzi Abi-Akar; Paul Achouh; Thomas Cuisset; Pascal Leprince; Eloi Marijon; Hervé Le Breton; Antoine Lafont

doi:10.1016/j.jacc.2019.09.054

Journal of the American College of Cardiology

Volume 74, Issue 22, December 2019 DOI: 10.1016/j.jacc.2019.09.054

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Femoral Versus Nonfemoral Peripheral Access for Transcatheter Aortic Valve Replacement

Sylvain Beurtheret, Nicole Karam, Noemie Resseguier, Remi Houel, Thomas Modine, Thierry Folliguet, Chekrallah Chamandi, Olivier Com, Richard Gelisse, Jacques Bille, Patrick Joly, Nicolas Barra, Alain Tavildari, Philippe Commeau, Sebastien Armero, Mathieu Pankert, Michel Pansieri, Sabrina Siame, René Koning, Marc Laskar, Yvan Le Dolley, Arnaud Maudiere, Bertrand Villette, Patrick Khanoyan, Julien Seitz, Didier Blanchard, Christian Spaulding, Thierry Lefevre, Eric Van Belle, Martine Gilard, Helene Eltchaninoff, Bernard Iung, Jean Philippe Verhoye, Ramzi Abi-Akar, Paul Achouh, Thomas Cuisset, Pascal Leprince, Eloi Marijon, Hervé Le Breton and Antoine Lafont

Author + information

vol. 74 no. 22 2728-2739

DOI:

https://doi.org/10.1016/j.jacc.2019.09.054

Published By:

Journal of the American College of Cardiology

Print ISSN:

0735-1097

Online ISSN:

1558-3597

History:

Received May 17, 2019
Revision received September 12, 2019
Accepted September 15, 2019
Published online November 25, 2019.

2019 The Authors

Author Information

Sylvain Beurtheret, MD^a,^∗ (sbeurtheret{at}hopital-saint-joseph.fr), @Beurtheretsylv1,
Nicole Karam, MD, PhD^b,^c,^d @nickaram,
Noemie Resseguier, MD^e,
Remi Houel, MD^a,
Thomas Modine, MD, PhD^f,
Thierry Folliguet, MD, PhD^g,
Chekrallah Chamandi, MD^b,^c,^d,
Olivier Com, MD^h,
Richard Gelisse, MD^h,
Jacques Bille, MD^h,
Patrick Joly, MD^h,
Nicolas Barra, MD^h,
Alain Tavildari, MD^h,
Philippe Commeau, MDⁱ,
Sebastien Armero, MD^j,
Mathieu Pankert, MD^k,
Michel Pansieri, MD^k,
Sabrina Siame^a,
René Koning, MD^l,
Marc Laskar, MD, PhD^m,
Yvan Le Dolley, MD^a,
Arnaud Maudiere, MD^a,
Bertrand Villette, MD^a,
Patrick Khanoyan, MD^h,
Julien Seitz, MD^h,
Didier Blanchard, MD^b,^c,^d,
Christian Spaulding, MD, PhD^b,^c,^d,
Thierry Lefevre, MDⁿ,
Eric Van Belle, MD, PhD^o,
Martine Gilard, MD, PhD^p,
Helene Eltchaninoff, MD, PhD^q,
Bernard Iung, MD, PhD^r,
Jean Philippe Verhoye, MD, PhD^s,
Ramzi Abi-Akar, MD^t,
Paul Achouh, MD, PhD^t,
Thomas Cuisset, MD, PhD^u,
Pascal Leprince, MD, PhD^v,
Eloi Marijon, MD, PhD^b,^c,^d @EloiMarijon,
Hervé Le Breton, MD, PhD^w and
Antoine Lafont, MD, PhD^b,^c,^d

^aCardiac Surgery Department, Saint Joseph Hospital, Marseille, France
^bParis Cardiovascular Research Center, INSERM Unit 970, Paris, France
^cUniversité Paris Descartes, Sorbonne Paris Cité, Paris, France
^dAssistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France
^eDepartment of Biostatistics and Public Health, La Timone Hospital, Marseille, France
^fCardiac Surgery Department, Cardiologic University Hospital, Lille, France
^gDepartment of Cardiothoracic Surgery and Transplantation, University of Lorraine, Centre Hospitalier Universitaire Brabois, Vandoeuvre les Nancy, France
^hCardiology Department, Saint Joseph Hospital, Marseille, France
ⁱDepartment of Cardiology, Clinique des Fleurs Ollioules, Ollioules, France
^jDepartment of Cardiology, Hôpital Européen, Marseille, France
^kDepartment of Cardiology, Centre Hospitalier Henri Duffaut, Avignon, France
^lCardiology Service, Saint Hilaire Clinic, Rouen, France
^mDepartment of Cardiac Surgery, Centre Hospitalier Dupuytren, Limoges, France
ⁿParis South Cardio-vascular Institute, Jacques-Cartier Private Hospital, Massy, France
^oDepartment of Cardiology, University of Lille 2, Regional University Hospital Centre of Lille, National Institute of Health and Medical Research U1011, University Hospital Federation Integra, Lille, France
^pDepartment of Cardiology, La Cavale Blanche University Hospital Centre, Optimization of Physiological Regulations, Science and Technical Training And Research Unit, University of Western Brittany, Brest, France
^qCardiology Service, Rouen–Charles-Nicolle University Hospital Centre, National Institute of Health and Medical Research U644, Rouen, France
^rDepartment of Cardiology, University Hospital Department Fire and Paris-Diderot University, Public Assistance Hospitals of Paris, Bichat Hospital, Paris, France
^sThoracic and Cardiovascular Surgery Service, Pontchaillou University Hospital Centre, University of Rennes 1, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
^tCardiac Surgery Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Cardiology Department, Paris, France
^uCardiology Department, La Timone Hospital, Marseille, France
^vCardiac Surgery Department, Sorbonne–Pierre-et-Marie-Curie University, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier de la Pitié Salpêtrière, Paris, France
^wCardiology and Vascular Diseases Service, Pontchaillou University Hospital Centre, Centre for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment Laboratory, National Institute of Health and Medical Research U1099, Rennes, France

↵∗Address for correspondence:
Dr. Sylvain Beurtheret, Saint Joseph Hospital, Cardiac Surgery Department, 26 bd de Louvain, 13008 Marseille, France.

Central Illustration

Abstract

Background Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Guidelines recommend reconsidering surgery when this access is not feasible. However, alternative peripheral accesses exist, although they have not been accurately compared with femoral access.

Objectives This study compared nonfemoral peripheral (n-FP) TAVR with femoral TAVR.

Methods Using the data from the national prospective French registry (FRANCE TAVI [French Transcatheter Aortic Valve Implantation]), this study compared the characteristics and outcomes of TAVR procedures according to whether they were performed through a femoral or a n-FP access, using a pre-specified propensity score−based matching between groups. Subanalysis during 2 study periods (2013 to 2015 and 2016 to 2017) and among low/intermediate-low and intermediate-high/high volume centers were performed.

Results Among 21,611 patients, 19,995 (92.5%) underwent femoral TAVR and 1,616 (7.5%) underwent n-FP TAVR (transcarotid, n = 914 or trans-subclavian, n = 702). Patients in the n-FP access group had more severe disease (mean logistic EuroSCORE 19.95 vs. 16.95; p < 0.001), with a higher rate of peripheral vascular disease, known coronary artery disease, chronic pulmonary disease, and renal failure. After matching, there was no difference in the rate of post-procedural death and complications according to access site, except for a 2-fold lower rate of major vascular complications (odds ratio: 0.45; 95% confidence interval: 0.21 to 0.93; p = 0.032) and unplanned vascular repairs (odds ratio: 0.41; 95% confidence interval: 0.29 to 0.59; p < 0.001) in those who underwent n-FP access. The comparison of outcomes provided similar results during the second study period and in intermediate-high/high volume centers.

Conclusions n-FP TAVR is associated with similar outcomes compared with femoral peripheral TAVR, except for a 2-fold lower rate of major vascular complications and unplanned vascular repairs. n-FP TAVR may be favored over surgery in patients who are deemed ineligible for femoral TAVR and may be a safe alternative when femoral access risk is considered too high.

Key Words

Footnotes

Edwards Lifesciences and Medtronic partly funded the FRANCE TAVI registry. Dr. Karam has received consultant fees from Abbott. Dr. Modine has been a consultant for Abbott, Edwards Lifesciences, Medtronic, and Microport. Dr Commeau has received consultant fees from Edwards, Abbott, and Boston Scientific. Dr. Koning has clinical research relationships with Boehringer Ingelheim, Boston Scientific, Abbott, Biosensor, and Biotronik. Dr. Seitz is a shareholder in Volta Medical; and has received consulting fees from Biosense Webster and Abbott. Dr. Spaulding has been a consultant for Medtronic. Dr. Spaulding has received consulting fees from Abiomed, Zoll, Medtronic, and Medpass. Dr. Lefevre has served as a proctor for Edwards Lifesciences and Abbott. Dr. Eltchaninoff has served as a proctor for and received lecture fees from Edwards Lifesciences. Dr. Iung has been a consultant for Edwards Lifesciences; and has received speaker fees from Boehringer Ingelheim and Novartis. Dr. Leprince has served as a proctor for Medtronic and Edwards. Dr. Le Breton has received speaker fees from Edwards Lifesciences and Medtronic. Dr. Lafont has served as a proctor for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.