The NORTh Europe HOStile access TAVI (NORTHOSTAVI) registry

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Vascular Surgery

Background:

• Transcatheter aortic valve implantation (TAVI) is a crucial treatment for aortic stenosis.
• Patients with hostile vascular access present unique challenges for TAVI procedures.
• Limited comparative data exists for alternative TAVI access routes in this patient population.

Purpose of the Study:

• To conduct a head-to-head comparison of various endovascular access routes for TAVI.
• To evaluate 30-day outcomes in patients with hostile vascular access undergoing TAVI.
• To identify potential risks associated with different TAVI access techniques.

Main Methods:

• The NORTHOSTAVI international registry included 531 patients undergoing TAVI via alternative endovascular transarterial access routes.
• Primary endpoint: adjusted 30-day composite rate of mortality, disabling stroke, major access site vascular complications, and major bleeding (VARC-3 criteria).
• Compared techniques included transcarotid (TCar), percutaneous transaxillary (P-TAx), surgically-assisted transaxillary (S-TAx), and angioplasty-assisted transfemoral (PTA-TF).

Main Results:

• Technical success was high (95%), with similar 30-day overall survival (97%) and event-free survival (91%) across groups.
• Percutaneous transaxillary (P-TAx) access was associated with increased adjusted risk of stroke compared to transcarotid (TCar) access.
• Angioplasty-assisted transfemoral (PTA-TF) access showed an increased adjusted risk of major vascular complications at the access site compared to TCar.

Conclusions:

• TAVI via diverse endovascular transarterial routes is feasible and safe in patients with hostile iliofemoral anatomy.
• Transcarotid access appears to be a favorable reference point for safety regarding stroke and vascular complications.
• Careful selection of access route is crucial to mitigate specific procedural risks in challenging TAVI cases.