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PAD tied to worse outcomes in transfemoral TAVR
In patients undergoing transfemoral transcatheter aortic valve replacement, the risks for death, hospital readmission and bleeding were higher among those with peripheral artery disease, as compared with those without the disease, according to new data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
After 1-year follow-up, patients with PAD vs. those without PAD undergoing TAVR via transfemoral access had higher incidences of death (16.8% vs. 14.4%), readmission (45.5% vs. 42.1%) and bleeding (23.1% vs. 19.7%).
After adjustment for baseline characteristics in patients who underwent transfemoral TAVR, the risks for death (adjusted HR = 1.14; P = .01), readmission (aHR = 1.11; P < .001) and bleeding (aHR = 1.18; P < .001) were elevated in patients with PAD vs. patients without PAD.
The increased risks for death and readmission among patients with PAD vs. without PAD were apparent during the first 30 days after the procedure and from 30 days to 1 year. The increased risk for bleeding, however, was mostly seen during the periprocedural period, the researchers noted.
In contrast to these findings, among patients undergoing TAVR via nontransfemoral access, those with PAD vs. those without PAD only had higher risk for bleeding (aHR = 1.22; P < .001).
“Further work is necessary to reduce adverse outcomes among patients with PAD undergoing TAVR,” the researchers wrote.
Using the STS/ACC Transcatheter Valve Therapy Registry linked to Medicare claims data, the researchers identified 27,440 patients aged at least 65 years undergoing TAVR and conducted analyses according to access site. Of the 19,660 patients undergoing transfemoral TAVR, 24.5% had PAD, and of the 7,780 undergoing nontransfemoral TAVR, 47.9% had PAD.
Of the patients who underwent nontransfemoral TAVR, the majority of those with PAD (67.4%) and those without PAD (69%) underwent transapical TAVR.
In both access-site groups, patients with PAD were younger, were more likely to be men and had greater prevalence of hypertension, diabetes, coronary artery and cerebrovascular diseases, prior stroke and HF within the 2 weeks before TAVR. They were also more frequently treated with larger valves, according to the data. – by Melissa Foster
Disclosure: Please see the study for a full list of the authors’ relevant financial disclosures.