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Cerebrovascular events with self-expanding versus balloon-expandable valves in patients with or without peripheral

Tullio Palmerini1, Francesco Saia1, Antonio Giulio Bruno1

  • 1Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac Thoracic and Vascular Department, Università di Bologna, Bologna, Italy.

The Journal of Invasive Cardiology
|February 24, 2025
PubMed

Insights

Self-expanding valves (SEV) showed a higher risk of cerebrovascular events (CVE) in patients with peripheral artery disease (PAD) compared to balloon-expandable valves (BEV). This risk was not observed in patients without PAD undergoing transcatheter aortic valve replacement.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Peripheral artery disease (PAD) complicates transcatheter aortic valve replacement (TAVR) procedures.
  • The choice of valve prosthesis, self-expanding valves (SEV) versus balloon-expandable valves (BEV), may influence periprocedural risks, particularly cerebrovascular events (CVE).
  • Access route and PAD complexity (Hostile score) are critical factors in TAVR outcomes.

Purpose of the Study:

  • To compare the risk of CVE between SEV and BEV in patients with and without PAD undergoing TAVR.
  • To stratify the risk based on access route and PAD complexity (Hostile score).

Main Methods:

  • An observational study (HOSTILE Registry) of 1707 patients with severe PAD undergoing TAVR analyzed CVE risk between SEV and BEV.
  • A meta-analysis of randomized controlled trials (RCTs) compared SEV and BEV in patients without PAD undergoing transfemoral access (TFA)-TAVR.
  • The primary endpoint was the 30-day risk of CVE.

Main Results:

  • In patients with PAD (n=1021), SEV use was associated with a higher 30-day (aHR, 2.70) and 1-year (aHR, 2.98) risk of CVE compared to BEV.
  • No significant interaction was found between valve type and access route or Hostile score in the PAD cohort.
  • In patients without PAD (n=2131) from RCTs, no significant difference in 30-day CVE rates was observed between SEV and BEV.

Conclusions:

  • SEVs are associated with an increased risk of CVE in TAVR patients with PAD.
  • This elevated risk in patients with PAD is not seen in patients with suitable femoral arteries included in RCTs.
  • Valve selection in TAVR should consider patient-specific factors like PAD severity and access route.
Abstract

Keywords:
TAVRalternative accessfemoral accesstranscatheter aortic valve replacement

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