Outcomes of Combined Transcatheter Aortic Valve Replacement and Peripheral Vascular Intervention in the United States.

Abstract

The aim of this study was to compare the prevalence and real-world outcomes of patients who require peripheral vascular intervention during the same hospitalization as transcatheter aortic valve replacement (TAVR) compared with TAVR alone. There are limited data on the prevalence and outcomes of combined TAVR and percutaneous peripheral vascular intervention. All patients who underwent TAVR in 2016 and 2017 were identified using the Nationwide Readmissions Database. Outcomes of patients undergoing TAVR alone were compared with those of patients undergoing combined TAVR and peripheral intervention, TAVR and peripheral intervention with and without a history of peripheral artery disease, and alternative-access TAVR with transfemoral TAVR in individuals undergoing peripheral intervention. The primary outcome was in-hospital mortality. A total of 99,654 hospitalizations were identified, among which 4,397 patients (4.42%) underwent peripheral intervention during the same admission as TAVR. Patients who required peripheral intervention had increased mortality (4.2% vs 1.5%; P< 0.001), stroke (3.5% vs 1.8%; P< 0.001), acute kidney injury (17.6% vs 10.8%; P< 0.001), blood transfusion (16.0% vs 11.3%; P< 0.001), 30-day readmission (16.3% vs 12.1%; P< 0.001), median length of stay (4days [IQR: 2-8days] vs 3days [IQR: 2-5days]; P< 0.001), and hospitalization charges. Compared with patients undergoing peripheral intervention to facilitate transfemoral TAVR, alternative-access TAVR was associated with increased mortality (4.6% vs 3.0%; P=0.036), acute kidney injury (22.7% vs 14.3%; P< 0.001), median length of stay (5days [IQR: 3-10days] vs 4days [IQR: 2-7days]; P< 0.001), and 30-day readmission (18.1% vs 15.5%; P=0.012). Peripheral vascular intervention may be used to facilitate transfemoral access or as a bailout for vascular complications during TAVR. Combined TAVR and peripheral intervention is associated with an increased risk for adverse events, though outcomes are better compared with alternative-access TAVR using a nonfemoral approach.