What happens when TAVR patients also require a peripheral vascular intervention

Patients treated with transcatheter aortic valve replacement (TAVR) and a peripheral vascular intervention during the same hospitalization may face a much higher risk of poor in-hospital outcomes, according to new research published in JACC: Cardiovascular Interventions.

“Peripheral artery disease (PAD) is common in the U.S. population and is especially common in patients with severe aortic stenosis who are candidates for TAVR,” wrote lead author Agam Bansal, MD, of the department of internal medicine at Cleveland Clinic, and colleagues. “The prevalence of clinically significant PAD has ranged from 4.1% to 43% in clinical trials of TAVR to date, and it is a commonly encountered in elderly patients with valvular heart disease.”

Bansal et al. noted that these TAVR patients with PAD often require post-TAVR vascular interventions. However, few studies have focused on outcomes associated with such interventions.

To help learn more about this topic, the group tracked data from nearly 100,000 TAVR patients who were treated from 2016 to 2017. All data came from the Nationwide Readmissions Database.

Overall, out of 99,654 TAVR patients, 4.42% also underwent a peripheral intervention during the same hospitalization. These patients were associated with a much higher mortality (4.2%) than patients who did not require a peripheral intervention (1.8%). TAVR patients who undergo these added interventions are also associated with higher rates of acute kidney injury (AKI), blood transfusions, 30-day readmissions and costs. In addition, the median length of stay was a full day longer for patients who also underwent a peripheral intervention.

The authors also found that patients who underwent a peripheral intervention to facilitate transfemoral access during TAVR or as a “bailout” for vascular complications during TAVR experienced better in-hospital outcomes than those who underwent alternative-access TAVR.

“Importantly, our study is the first to show that patients who undergo nonfemoral access TAVR using an alternative surgical cut-down route may have worse in-hospital outcomes, including increased mortality, AKI, 30-day readmission, and lengths of stay, compared with patients treated with transfemoral TAVR who require peripheral vascular intervention,” the authors wrote. “Although our study lacks granularity as to the severity and nature of PAD in this cohort, our findings suggest that the use of peripheral vascular intervention to facilitate transfemoral TAVR in patients with PAD might be a safer strategy than alternative-access TAVR if it is feasible.”

The team did add that more research is needed to confirm these findings.

The full study is available here.

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