Related Experiment Video
Updated: Nov 17, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Clinical Impact of Crossover Techniques for Primary Access Hemostasis in Transfemoral Transcatheter Aortic Valve
Lucía Junquera1, Marina Urena, Azeem Latib
1Quebec Heart & Lung Institute, Laval University, 2725, Chemin Sainte-Foy, Québec, Canada G1V 4G5. josep.rodes@criucpq.ulaval.ca.
Insights
The crossover technique (COT) in transfemoral transcatheter aortic valve replacement (TAVR) did not reduce major vascular complications. However, obese patients may benefit from COT, suggesting a tailored approach for TAVR candidates.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Transfemoral transcatheter aortic valve replacement (TAVR) is a key treatment for aortic stenosis.
- Vascular complications (VCs) remain a concern following TAVR procedures.
- The crossover technique (COT) has been proposed to mitigate VCs, but data with newer devices are limited, especially in high-risk obese patients.
Purpose of the Study:
- To evaluate the association between the crossover technique (COT) and vascular complications (VCs) after transfemoral TAVR using new-generation devices.
- To assess the efficacy of COT in reducing VCs, particularly in obese patients undergoing TAVR.
Main Methods:
- A multicenter study analyzed 2214 patients undergoing transfemoral TAVR.
- Patients were divided into two groups: those who underwent COT (1522 patients) and those who did not (692 patients).
- Thirty-day outcomes, including VCs, bleeding, and mortality, were compared using multivariate logistic regression, with a subanalysis for obese patients.
Main Results:
- No significant difference in major VCs, major/life-threatening bleeding, or mortality was observed between COT and no-COT groups.
- Minor VCs and postprocedural acute renal failure were higher in the COT group.
- In obese patients, COT was associated with a trend towards fewer VCs and reduced percutaneous closure device failure.
Conclusions:
- The crossover technique (COT) did not demonstrate a reduction in major vascular complications or improved overall outcomes in TAVR patients.
- Obese patients may represent a subset who could benefit from COT, warranting further investigation.
- A personalized, risk-benefit-assessed strategy for COT application in TAVR candidates is recommended.
Objectives:
To determine the occurrence of vascular complications (VCs) following transfemoral transcatheter aortic valve replacement (TAVR) with new-generation devices according to the use of a crossover technique (COT).
Background:
The use of a COT (with/without balloon) has been associated with a reduction of VCs in TAVR patients. However, scarce data support its use with second-generation devices. Also, its potential benefit in obese patients (at high-risk of VCs) has not been elucidated.
Methods:
A multicenter study including 2214 patients who underwent full percutaneous transfemoral TAVR (COT, 1522 patients; no COT, 692 patients). Thirty-day events were evaluated according to the use of a COT using a multivariate logistic regression model. A subanalysis was performed in obese patients.
Results:
Primary access major VCs (3.5% COT vs 3.9% no COT; P=.19), major/life-threatening bleeding (3.4% COT vs 2.0% no COT; P=.33), and mortality rates (2.4% COT vs 2.6% no COT; P=.23) were similar between groups. However, minor VCs (11.7% COT vs 5.9% no COT; P<.001) and postprocedural acute renal failure (8.9% COT vs 3.9% no COT; P<.001) were higher in patients undergoing the COT. In the overall cohort, percutaneous closure device failure was more frequent in obese patients (4.0% in the obese group vs 1.9% in the non-obese group; P<.01), but these differences were no longer significant in those undergoing a COT (3.4% in the obese group vs 2.0% in the non-obese group; P=.12). Indeed, in the subset of obese patients, the COT tended to be associated with fewer VCs (3.4% COT vs 5.9% no COT; P=.09).
Conclusions:
The use of a COT was not associated with a reduction of major VCs or improved outcomes. However, some patient subsets, such as those with higher body mass index, may benefit from the use of a COT. These findings would suggest the application of a tailored strategy, following a risk-benefit assessment in each TAVR candidate.
