The Impact of Vascular Access Complications in Patients Undergoing Transcatheter Aortic Valve Replacement

Vascular complications remain a significant concern in transfemoral transcatheter aortic valve replacement (TAVR).

Determine the incidence of vascular complications following TAVR and evaluate their impact on short- and long-term clinical outcomes.

We conducted a retrospective observational analysis of patients undergoing transfemoral TAVR at a single institution. Patients were stratified into three groups: Group 0 (no perioperative complications), Group 1 (vascular complications), and Group 2 (non-vascular complications). The primary outcome was early- and late-mortality. Propensity score matching was performed to compare outcomes between Group 0 and Group 1.

Among 5230 patients, 4391 (84.0%) were in Group 0, 154 (2.9%) in Group 1, and 685 (13.1%) in Group 2. In Group 1, 36.4% experienced intraoperative bleeding requiring intervention, 27.3% had intraoperative limb ischemia or dissection, and 16.2% required postoperative takeback for limb ischemia. In-hospital mortality was 12/154 (7.8%) in Group 1, compared with 7/4391 (0.2%) in Group 0 and 45/685 (6.6%) in Group 2 (p < 0.001). Thirty-day mortality was 16/154 (10.4%) in Group 1 versus 117/4391 (2.7%) in Group 0 and 70/685 (10.2%) in Group 2 (p < 0.001). Propensity-matched analysis showed Group 1 had fourfold higher 30-day mortality (OR 4.02, 95% CI 1.98-8.18, p < 0.001). One-year mortality was 29/148 (19.6%) for Group 1 compared with 72/592 (12.2%) for Group 0, with 5-year survival similar between groups (Group 1: 51.1%, Group 0: 50.9%, log-rank p = 0.214), while unmatched Group 2 had 43.1% 5-year survival.

While vascular complications after TAVR are uncommon, they are linked to substantially worse early outcomes, whereas long-term survival among patients who survive the initial postoperative period remains comparable, emphasizing the critical impact during the early phase.