Sistema de Salut de Catalunya
Institut Català de la Salut
[Alperi A] Quebec Heart & Lung Institute, Laval University, Quebec City, Canada. [McInerney A] Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain. [Modine T] Centre Hospitalier Universitaire de Lille, Lille, France. [Chamandi C] Hôpital européen Georges-Pompidou, Paris, France. [Tafur-Soto JD] The Ochsner Clinical School, Ochsner Medical Center, New Orleans, LA, USA. [Barbanti M] Ferrarotto Hospital, University of Catania, Catania, Italy. [Serra V] Vall d’Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2022-09-09T14:54:10Z
2022-09-09T14:54:10Z
2022-06
Obesity; Transcarotid; Transfemoral
Obesidad; Transcarotídea; Transfemoral
Obesitat; Transcaròtida; Transfemoral
OBJECTIVES 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. METHODS 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). RESULTS 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%). CONCLUSIONS 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.
Article
Versió publicada
Anglès
Vàlvula aòrtica - Estenosi - Cirurgia; Persones obeses; Cateterisme cardíac - Complicacions; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Cardiac Surgical Procedures::Heart Valve Prosthesis Implantation::Transcatheter Aortic Valve Replacement; Other subheadings::Other subheadings::Other subheadings::/adverse effects; DISEASES::Pathological Conditions, Signs and Symptoms::Signs and Symptoms::Body Weight::Overweight::Obesity; DISEASES::Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases::Aortic Valve Stenosis; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos cardíacos::implantación de prótesis valvulares cardíacas::sustitución valvular aórtica con catéter; Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos; ENFERMEDADES::afecciones patológicas, signos y síntomas::signos y síntomas::peso corporal::sobrepeso::obesidad; ENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::enfermedades de las válvulas cardíacas::estenosis de la válvula aórtica
Oxford University Press
Interactive CardioVascular and Thoracic Surgery;34(6)
https://doi.org/10.1093/icvts/ivab354
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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