Predicting vascular complications during TAVR just got a little easier
A new risk score can accurately predict when transcatheter aortic valve replacement (TAVR) patients face an increased risk of nonpuncture site vascular complications, according to new data published in JACC: Cardiovascular Interventions.[1] The score also showed “modest” potential to anticipate possible puncture site vascular complications.
“Current guidelines for the management of valvular heart disease consider transfemoral TAVR as a class I recommendation for elderly or high-surgical-risk patients with severe, symptomatic aortic stenosis and suitable anatomy,” wrote corresponding author Thomas Pilgrim, MD, MSc, a cardiologist with the University of Bern in Switzerland, and colleagues. “Vascular complications are the most common complications of transfemoral TAVR and remain a major concern. The evaluation of iliofemoral access anatomy is important in the choice between transcatheter and surgical intervention and between transfemoral and non-transfemoral approaches. A systematic approach is needed for a standardized assessment of the iliofemoral vascular anatomy.”
Researchers recently developed the Hostile score as a way to quantify atherosclerosis and evaluate the risk of TAVR complications in patients who present with peripheral artery disease.[2]
Hoping to learn more about the risk score’s potential, Pilgrim et al. assessed its ability to predict vascular complications after TAVR. They tracked data from more than 2,000 patients who underwent the procedure from March 2014 to June 2023. The mean patient age was 81.7 years old, 49.1% were women and the median Society of Thoracic Surgeons score was 3.5.
Overall, 6.6% of patients had iliofemoral vascular complications during TAVR. While 5.2% of patients had a puncture site complication, the other 1.4% had a nonpuncture site complication. Puncture site complications became less common as the study went on, the authors noted, but this was not the case for nonpuncture site complications.
The Hostile score was associated with area under the ROC curves for all iliofemoral vascular complications, puncture site vascular complications and nonpuncture site vascular complications of 0.616, 0.554 and 0.829, respectively. A higher Hostile score was an independent predictor of nonpuncture site vascular complications and “borderline significant” for the prediction of puncture site vascular complications.
Pilgrim and colleagues also explored patient outcomes, noting that all-cause mortality was not significant worse among patients with vascular complications during TAVR. The risk of cardiovascular death or stroke did occur more frequently in patients with vascular complications at 30 days, but that trend was no longer present after one year.
On the other hand, the researchers did find that patients with nonpuncture site complications faced significantly higher risks of all-cause mortality, cardiovascular death and stroke than patients without such complications.
“In the overall population, the Hostile score was a significant predictor of cardiovascular mortality but not of all-cause mortality and stroke at one year,” the authors emphasized.
Reviewing these findings, the group said evaluating the iliofemoral anatomy of patients prior to TAVR “has the potential to further improve clinical outcomes.” This helps cardiologists determine the best treatment strategy, for instance, and plan ahead for potential complications.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.