Femoral Versus Nonfemoral Peripheral Access ...
Document type :
Compte-rendu et recension critique d'ouvrage
PMID :
Title :
Femoral Versus Nonfemoral Peripheral Access for Transcatheter Aortic Valve Replacement
Author(s) :
Beurtheret, Sylvain [Auteur correspondant]
Hôpital Saint-Joseph [Marseille]
Karam, Nicole [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Resseguier, Noémie [Auteur]
Hôpital de la Timone [CHU - APHM] [TIMONE]
Houel, Remi [Auteur]
Hôpital Saint-Joseph [Marseille]
Modine, Thomas [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Folliguet, Thierry [Auteur]
Centre Hospitalier Régional Universitaire de Nancy [CHRU Nancy]
Chamandi, Chekrallah [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Com, Olivier [Auteur]
Hôpital Saint-Joseph [Marseille]
Gelisse, Richard [Auteur]
Hôpital Saint-Joseph [Marseille]
Bille, Jacques [Auteur]
Hôpital Saint-Joseph [Marseille]
Joly, Patrick [Auteur]
Hôpital Saint-Joseph [Marseille]
Barra, Nicolas [Auteur]
Hôpital Saint-Joseph [Marseille]
Tavildari, Alain [Auteur]
Hôpital Saint-Joseph [Marseille]
Commeau, Philippe [Auteur]
Armero, Sebastien [Auteur]
Pankert, Mathieu [Auteur]
Pansieri, Michel [Auteur]
Siame, Sabrina [Auteur]
Hôpital Saint-Joseph [Marseille]
Koning, René [Auteur]
Clinique Saint-Hilaire [Rouen]
Laskar, Marc [Auteur]
Le Dolley, Yvan [Auteur]
Hôpital Saint-Joseph [Marseille]
Maudiere, Arnaud [Auteur]
Hôpital Saint-Joseph [Marseille]
Villette, Bertrand [Auteur]
Hôpital Saint-Joseph [Marseille]
Khanoyan, Patrick [Auteur]
Hôpital Saint-Joseph [Marseille]
Seitz, Julien [Auteur]
Hôpital Saint-Joseph [Marseille]
Blanchard, Didier [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Spaulding, Christian [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Lefevre, Thierry [Auteur]
Van Belle, Eric [Auteur]
Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 [RNMCD]
Gilard, Martine [Auteur]
Université de Bretagne Occidentale - UFR Médecine et Sciences de la Santé [UBO UFR MSS]
Eltchaninoff, Hélène [Auteur]
Service de Cardiologie [CHU Rouen]
Pharmacologie des Dysfonctionnements Endotheliaux et Myocardiques
Iung, Bernard [Auteur]
CIC - CHU Bichat
Verhoye, Jean Philippe [Auteur]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
Laboratoire Traitement du Signal et de l'Image [LTSI]
Abi-Akar, Ramzi [Auteur]
Hôpital Européen Georges Pompidou [APHP] [HEGP]
Achouh, Paul [Auteur]
Service de chirurgie cardiaque et vasculaire [CHU HEGP]
Cuisset, Thomas [Auteur]
Hôpital de la Timone [CHU - APHM] [TIMONE]
Leprince, Pascal [Auteur]
CHU Pitié-Salpêtrière [AP-HP]
Marijon, Eloi [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Le Breton, Hervé [Auteur]
Laboratoire Traitement du Signal et de l'Image [LTSI]
Lafont, Antoine [Auteur]
Hôpital Européen Georges Pompidou [APHP] [HEGP]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Hôpital Saint-Joseph [Marseille]
Karam, Nicole [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Resseguier, Noémie [Auteur]
Hôpital de la Timone [CHU - APHM] [TIMONE]
Houel, Remi [Auteur]
Hôpital Saint-Joseph [Marseille]
Modine, Thomas [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Folliguet, Thierry [Auteur]
Centre Hospitalier Régional Universitaire de Nancy [CHRU Nancy]
Chamandi, Chekrallah [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Com, Olivier [Auteur]
Hôpital Saint-Joseph [Marseille]
Gelisse, Richard [Auteur]
Hôpital Saint-Joseph [Marseille]
Bille, Jacques [Auteur]
Hôpital Saint-Joseph [Marseille]
Joly, Patrick [Auteur]
Hôpital Saint-Joseph [Marseille]
Barra, Nicolas [Auteur]
Hôpital Saint-Joseph [Marseille]
Tavildari, Alain [Auteur]
Hôpital Saint-Joseph [Marseille]
Commeau, Philippe [Auteur]
Armero, Sebastien [Auteur]
Pankert, Mathieu [Auteur]
Pansieri, Michel [Auteur]
Siame, Sabrina [Auteur]
Hôpital Saint-Joseph [Marseille]
Koning, René [Auteur]
Clinique Saint-Hilaire [Rouen]
Laskar, Marc [Auteur]
Le Dolley, Yvan [Auteur]
Hôpital Saint-Joseph [Marseille]
Maudiere, Arnaud [Auteur]
Hôpital Saint-Joseph [Marseille]
Villette, Bertrand [Auteur]
Hôpital Saint-Joseph [Marseille]
Khanoyan, Patrick [Auteur]
Hôpital Saint-Joseph [Marseille]
Seitz, Julien [Auteur]
Hôpital Saint-Joseph [Marseille]
Blanchard, Didier [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Spaulding, Christian [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Lefevre, Thierry [Auteur]
Van Belle, Eric [Auteur]
Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 [RNMCD]
Gilard, Martine [Auteur]
Université de Bretagne Occidentale - UFR Médecine et Sciences de la Santé [UBO UFR MSS]
Eltchaninoff, Hélène [Auteur]
Service de Cardiologie [CHU Rouen]
Pharmacologie des Dysfonctionnements Endotheliaux et Myocardiques
Iung, Bernard [Auteur]
CIC - CHU Bichat
Verhoye, Jean Philippe [Auteur]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
Laboratoire Traitement du Signal et de l'Image [LTSI]
Abi-Akar, Ramzi [Auteur]
Hôpital Européen Georges Pompidou [APHP] [HEGP]
Achouh, Paul [Auteur]
Service de chirurgie cardiaque et vasculaire [CHU HEGP]
Cuisset, Thomas [Auteur]
Hôpital de la Timone [CHU - APHM] [TIMONE]
Leprince, Pascal [Auteur]
CHU Pitié-Salpêtrière [AP-HP]
Marijon, Eloi [Auteur]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Le Breton, Hervé [Auteur]
Laboratoire Traitement du Signal et de l'Image [LTSI]
Lafont, Antoine [Auteur]
Hôpital Européen Georges Pompidou [APHP] [HEGP]
Paris-Centre de Recherche Cardiovasculaire [PARCC - UMR-S U970]
Journal title :
Journal of the American College of Cardiology
Pages :
2728-2739
Publisher :
Elsevier
Publication date :
2019-12
ISSN :
0735-1097
English keyword(s) :
access site
outcome
TAVR
outcome
TAVR
HAL domain(s) :
Sciences du Vivant [q-bio]/Médecine humaine et pathologie/Cardiologie et système cardiovasculaire
Sciences du Vivant [q-bio]/Médecine humaine et pathologie/Chirurgie
Sciences du Vivant [q-bio]/Médecine humaine et pathologie/Chirurgie
English abstract : [en]
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, ...
Show more >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.Show less >
Show more >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.Show less >
Language :
Anglais
Popular science :
Non
Source :
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