Secondary access and routine protection wire for transfemoral transcatheter aortic valve replacement: the SURF-TAVR...

Vascular complications remain a challenge in transfemoral transcatheter aortic valve replacement (TF-TAVR). Evidence for routine wire protection (RP) to mitigate these complications is limited.

This study assessed the impact of RP on vascular complications in a contemporary TF-TAVR cohort.

The SURF-TAVR registry analyzed 4224 TF-TAVR patients treated between January 2020 and August 2023 at 15 centers in Italy and France. Patients were categorized into RP or no-routine protection (nRP) centers. Propensity score matching (PSM) adjusted for baseline differences. The primary endpoint was overall vascular complications (VARC-3 criteria). Secondary outcomes included major vascular complications, bleeding, acute kidney injury, and intrahospital mortality.

Of the analyzed patients, 69.1% were treated in nRP centers and 30.9% in RP centers. Secondary access was predominantly transradial in the nRP group (82%) and contralateral femoral in the RP group (87.5%). nRP was associated with fewer overall vascular complications (8.3% vs. 12.1%, p < 0.001), but more major vascular complications (2.4% vs. 1.1%, p = 0.009). Bleeding rates were lower with nRP (6.6% vs. 9.7%, p < 0.001), while major bleedings were comparable (3.8% vs 4.8%, p = 0.111). Propensity score matching confirmed these findings.

Routine wire protection in transfemoral TAVR is associated with increased overall vascular complications and bleeding, but appears to lower the risk of major vascular complications. These findings underscore the need to carefully weigh procedural risks and benefits to optimize vascular access management in TF-TAVR.