Nonfemoral TAVR Possible Alternative to Patients Ineligible for Femoral Access

Nonfemoral transcatheter aortic valve replacement (TAVR) may be preferred over surgery in patients deemed ineligible for femoral TAVR, new study results suggest.

“Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Guidelines recommend reconsidering surgery when this access is not feasible,” the researchers explained, publishing their findings in the Journal of the American College of Cardiology. “However, alternative peripheral accesses exist, although they have not been accurately compared with femoral access.”

The study included 21,611 patients in the French registry, the study looked at characteristics and outcomes of TAVR procedures based on whether they were performed through femoral or nonfemoral access. The researchers then performed a subanalysis during two study periods and among the low/intermediate and intermediate-high/high volume centers. Of the more than 21,000 patients in the study, 19,995 (92.5%) underwent femoral TAVR and 1,616 (7.5%) underwent nonfemoral TAVR.

According to the study results, patients in the nonfemoral access group had severe disease and higher rates of peripheral vascular disease, known coronary artery disease, chronic pulmonary disease, and renal failure. The researchers, after propensity-matching, reported no differences in the rate of post-procedural death and complications based on access site. They did, however, report a two-fold lower rate of major vascular complications (OR=0.45; 95% CI, 0.21 to 0.93; P=0.032) and unplanned vascular repairs (OR=0.41; 95% CI, 0.29 to 0.59; P<0.001) in the nonfemoral access group. The initial results were similar in the analysis of the second study period and also in the intermediate-high/high volume centers.

“Nonfemoral peripheral TAVR is associated with similar outcomes compared with femoral peripheral TAVR, except for a two-fold lower rate of major vascular complications and unplanned vascular repairs,” the authors concluded. “Nonfemoral peripheral 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.”