TY - JOUR
T1 - The Impact of THV Platforms on Transfemoral TAVR in Complex Vascular Access
T2 - Insights From the Hostile Registry
AU - Fraccaro, Chiara
AU - Palmerini, Tullio
AU - Lorenzoni, Giulia
AU - Saia, Francesco
AU - Kim, Won Keun
AU - Iadanza, Alessandro
AU - De Backer, Ole
AU - Burzotta, Francesco
AU - Trani, Carlo
AU - Van Mieghem, Nicolas M.
AU - Pilgrim, Thomas
AU - Aranzulla, Tiziana Claudia
AU - Meertens, Max M.
AU - Joner, Michael
AU - Meucci, Francesco
AU - Toggweiler, Stefan
AU - Testa, Luca
AU - Berti, Sergio
AU - Montorfano, Matteo
AU - Braun, Daniel
AU - Castriota, Fausto
AU - De Carlo, Marco
AU - Barbanti, Marco
AU - Stefanini, Giulio
AU - Nickenig, Georg
AU - Piva, Tommaso
AU - Latib, Azeem
AU - Porto, Italo
AU - Kornowski, Ran
AU - Bartorelli, Antonio L.
AU - Abdel-Wahab, Mohamed
AU - Gregori, Dario
AU - Tarantini, Giuseppe
N1 - Publisher Copyright:
© 2025 Wiley Periodicals LLC.
PY - 2025/10/1
Y1 - 2025/10/1
N2 - Background:The choice of transcatheter heart valve (THV) platform, including self-expanding valves (SEVs) and balloon-expandable valves (BEVs), may influence outcomes in patients with peripheral artery disease (PAD) undergoing transfemoral transcatheter aortic valve replacement (TAVR). This relationship remains underexplored in high-risk populations with challenging vascular access.Aims: This study assessed the impact of SEVs and BEVs on clinical outcomes in PAD patients, considering hostile score severity. Methods: This sub-analysis of the Hostile Registry included 419 TAVR patients (47% SEVs, 53% BEVs). Outcomes, including all-cause mortality, stroke, vascular complications, and major bleeding were evaluated at 30 days and 1 year. Logistic regression and Cox proportional hazard models assessed associations, with interaction terms exploring the modifying effect of valve type by hostile score severity.Results:No significant differences emerged between SEVs and BEVs for 30-day and 1-year outcomes. However, in SEVs recipients, a high hostile score was associated with worse outcomes, including 1-year all-cause mortality (HR 2.81, p = 0.033), stroke (HR 18.26, p = 0.008), major bleeding (HR 2.49, p = 0.033), and MACCE (HR 4.34, p < 0.001). Interaction terms were not statistically significant, although a trend for MACCE (p = 0.0598) was noted. Conclusions: SEVs and BEVs demonstrated comparable outcomes overall, high hostile score were associated with worse outcomes in the SEV group. Nonetheless, there was a trend suggesting a difference between the two valves in this setting, and further studies are needed to confirm potential valve-specific differences in high-risk populations and to refine personalized valve selection.
AB - Background:The choice of transcatheter heart valve (THV) platform, including self-expanding valves (SEVs) and balloon-expandable valves (BEVs), may influence outcomes in patients with peripheral artery disease (PAD) undergoing transfemoral transcatheter aortic valve replacement (TAVR). This relationship remains underexplored in high-risk populations with challenging vascular access.Aims: This study assessed the impact of SEVs and BEVs on clinical outcomes in PAD patients, considering hostile score severity. Methods: This sub-analysis of the Hostile Registry included 419 TAVR patients (47% SEVs, 53% BEVs). Outcomes, including all-cause mortality, stroke, vascular complications, and major bleeding were evaluated at 30 days and 1 year. Logistic regression and Cox proportional hazard models assessed associations, with interaction terms exploring the modifying effect of valve type by hostile score severity.Results:No significant differences emerged between SEVs and BEVs for 30-day and 1-year outcomes. However, in SEVs recipients, a high hostile score was associated with worse outcomes, including 1-year all-cause mortality (HR 2.81, p = 0.033), stroke (HR 18.26, p = 0.008), major bleeding (HR 2.49, p = 0.033), and MACCE (HR 4.34, p < 0.001). Interaction terms were not statistically significant, although a trend for MACCE (p = 0.0598) was noted. Conclusions: SEVs and BEVs demonstrated comparable outcomes overall, high hostile score were associated with worse outcomes in the SEV group. Nonetheless, there was a trend suggesting a difference between the two valves in this setting, and further studies are needed to confirm potential valve-specific differences in high-risk populations and to refine personalized valve selection.
UR - https://www.scopus.com/pages/publications/105012123212
U2 - 10.1002/ccd.70061
DO - 10.1002/ccd.70061
M3 - Article
C2 - 40734333
AN - SCOPUS:105012123212
SN - 1522-1946
VL - 106
SP - 2189
EP - 2200
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 4
ER -