Characteristics, Trends, and Outcomes of Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Replacement in United States

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2024-10-28 DOI:10.1016/j.jcin.2024.08.033

Hafiz M. Imran MD , Phinnara Has MS , Nicholas Kassis MD , Ernie Shippey MS , Ahmed Elkaryoni MD , Paul C. Gordon MD , Barry L. Sharaf MD , Peter A. Soukas MD , Omar N. Hyder MD , Frank Sellke MD , Afshin Ehsan MD , Neel Sodha MD , Amgad Mentias MD, MS , Islam Y. Elgendy MD , Mohamad Alkhouli MD , J. Dawn Abbott MD , Herbert D. Aronow MD, MPH , Marwan Saad MD, PhD

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引用次数: 0

Abstract

Background

Transfemoral (TF) access is the preferred approach for transcatheter aortic valve replacement (TAVR). Limited data exist regarding the outcomes of intravascular lithotripsy (IVL)-assisted TF TAVR in patients with peripheral artery disease.

Objectives

This study sought to examine contemporary characteristics, trends, and outcomes of IVL TAVR in the United States.

Methods

The Vizient Clinical Database was queried for patients who underwent percutaneous TAVR between October 1, 2020, and November 30, 2023. Outcomes with IVL TAVR vs non–IVL TAVR were examined after propensity score matching. 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 of 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 the frequency remained low. IVL TAVR patients had a higher median Elixhauser comorbidity score (5 [Q1-Q3: 4-7] vs 4 [Q1-Q3: 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 propensity score matching 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

In the United States, IVL is increasingly adopted to facilitate TF TAVR. IVL TAVR patients exhibited a higher burden of comorbidities and experienced more complications compared to non–IVL TAVR patients. Further studies are needed to identify appropriate anatomical and clinical use criteria for IVL TAVR and to compare its outcomes vs alternative non–TF TAVR.

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美国血管内碎石辅助经股动脉经导管主动脉瓣置换术的特点、趋势和结果

背景经股动脉（TF）入路是经导管主动脉瓣置换术（TAVR）的首选入路。有关外周动脉疾病患者在血管内碎石术（IVL）辅助下进行经皮主动脉瓣置换术（TAVR）的结果数据有限。本研究旨在研究美国 IVL TAVR 的当代特征、趋势和结果。经过倾向得分匹配后，对 IVL TAVR 与非 IVL TAVR 的结果进行了研究。主要结果是院内死亡、中风、血管并发症、外科血管介入治疗和大出血的综合结果。结果在研究期间，361家医院的129655名患者（平均年龄78.4岁，42.2%为女性，87.1%为白人）接受了经皮TAVR，其中1242人（0.96%）接受了IVL TAVR。IVL TAVR呈上升趋势，但频率仍然很低。与非 IVL TAVR 相比，IVL TAVR 患者的中位 Elixhauser 合并症评分更高（5 [Q1-Q3: 4-7] vs 4 [Q1-Q3: 3-6]）。1238例（99.7%）IVL TAVR患者通过TF方法完成了TAVR。在3:1倾向得分匹配分析中，IVL TAVR与较高的主要复合结局发生率相关（21.9% vs 13.7%; P <0.001），原因是血管并发症、外科血管干预和大出血发生率较高。结论在美国，IVL越来越多地被用于TF TAVR。与非IVL TAVR患者相比，IVL TAVR患者的合并症负担更高，并发症也更多。还需要进一步研究，以确定 IVL TAVR 的适当解剖和临床使用标准，并将其结果与其他非 TTF TAVR 进行比较。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.