経皮的経ラジアル動脈および経大腿動脈アクセスによるバルーン大動脈弁形成術の比較有効性

Balloon aortic valvuloplasty (BAV) is commonly performed as a bridge to therapy, for stratification, or as a palliative procedure in cases of severe aortic stenosis. The complication rate of transfemoral access BAV (transfemoral valvuloplasty [TFV]) is comparable to that of transcatheter aortic valve replacement. Transradial access BAV (transradial valvuloplasty [TRV]) is technically feasible; however, comparative data for TFV are lacking. We aim to compare TFV and TRV in terms of technical and hemodynamic success, periprocedural safety, and short-term clinical outcomes.

Consecutive patients undergoing BAV at a tertiary center from 2021 to 2024 were assessed. TRV was performed with ultrasound guidance and an 8F short sheath equipped with compatible balloons. Hemodynamic success was defined as a reduction in gradient of 30% or more. The primary outcome was the periprocedural composite of a Valve Academic Research Consortium (VARC) 3 major vascular complication, grade 3 to 4 bleeding, and balloon entrapment, and nonaccess-related events, including complete heart block, periprocedural stroke, hypotension, severe aortic insufficiency, and periprocedural death. The secondary outcome was the 30-day composite of all-cause mortality, cardiac-related hospitalization, and discharge failure. Inverse probability of treatment weighting, followed by multivariate regression, was employed to address confounders.

105 TRV and 148 TFV were included. Technical success rate was 96.2% for TRV and 98.7% for TFV (P = .21). The primary outcome event rate was significantly lower in the TRV compared to the TFV group: 2.53% vs 17.47%; adjusted odds ratio, 0.13; 95% CI, 0.04-0.49; P = .003. Technical and hemodynamic success and secondary outcomes were comparable between TRV and TFV.

In comparison to TFV, TRV is associated with lower rates of periprocedural safety events while maintaining similar short-term clinical outcomes and hemodynamic performance.