BACKGROUND Transfemoral approach has been commonly used as secondary access in transcatheter aortic valve replacement (TAVR). Scarce data exist on the use and potential clinical benefits of the transradial approach as secondary access during TAVR procedures. The objective of the study is to determine the occurrence of vascular complications (VC) and clinical outcomes according to secondary access (transfemoral versus transradial) in patients undergoing TAVR. METHODS This was a multicenter study including 4949 patients who underwent TAVR (mean age, 81±8 years, mean Society of Thoracic Surgeons score, 4.9 [3.3-7.5]). Transfemoral and transradial approaches were used as secondary access in 4016 (81.1%) and 933 (18.9%) patients, respectively. The 30-day clinical events (vascular and bleeding complications, stroke, acute kidney injury, and mortality) were evaluated and defined according to Valve Academic Research Consortium-2 criteria. Clinical outcomes were analyzed according to the secondary access (transfemoral versus transradial) in the overall population and in a propensity score-matched population involving 2978 transfemoral and 928 transradial patients. RESULTS Related-access VC occurred in 834 (16.9%) patients (major VC, 5.7%) and were related to the secondary access in 172 (3.5%) patients (major VC, 1.3%). The rate of VC related to the secondary access was higher in the transfemoral group (VC, 4.1% versus 0.9%, P<0.001; major VC, 1.6% versus 0%, P<0.001). In the propensity score-matched population, VC related to the secondary access remained higher in the transfemoral group (4.7% versus 0.9%, P<0.001; major VC, 1.8% versus 0%, P<0.001), which also exhibited a higher rate of major/life-threatening bleeding events (1.0% versus 0%, P<0.001). Significant differences between secondary access groups were observed regarding the rates of 30-day stroke (transfemoral: 3.1%, transradial: 1.6%; P=0.043), acute kidney injury (transfemoral: 9.9%, transradial: 5.7%; P<0.001), and mortality (transfemoral: 4.0%, transradial: 2.4%, P=0.047). CONCLUSIONS The use of transradial approach as secondary access in TAVR procedures was associated with a significant reduction in vascular and bleeding complications and improved 30-day outcomes. Future randomized studies are warranted.

中文翻译：

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经导管主动脉瓣置换术中经股动脉与经radi动脉二次入路的比较。

背景技术经股动脉入路已普遍用作经导管主动脉瓣置换术（TAVR）中的辅助通路。关于在TAVR程序中作为第二次通路的经radi入方法的使用和潜在临床益处的数据很少。该研究的目的是根据接受TAVR的患者的继发途径（经股动脉还是经trans动脉）确定血管并发症（VC）的发生和临床结果。方法这是一项多中心研究，包括4949例行TAVR的患者（平均年龄81±8岁，平均胸外科医师评分4.9 [3.3-7.5]）。经股动脉和经radi动脉入路分别作为4016（81.1％）和933（18.9％）患者的二级通路。30天的临床事件（血管和出血并发症，中风，急性肾损伤，（和死亡率）进行评估并根据Valve学术研究联盟2标准进行定义。根据总人群和倾向评分匹配人群的次要通路（经股动脉与经trans动脉）分析临床结局，涉及2978名经股动脉和928名经radi动脉患者。结果834例（16.9％）患者发生了相关性VC（主要VC，5.7％），与172例（3.5％）患者中的次要访问相关（VC较大，1.3％）。经股组中与次要通路相关的VC发生率较高（VC，4.1％比0.9％，P <0.001；主要VC，1.6％比0％，P <0.001）。在倾向评分匹配的人群中，经股动脉组与次要通路相关的VC仍然较高（4.7％比0.9％，P <0.001；主要VC，1.8％比0％，P <0.001），它也表现出较高的主要/危及生命的出血事件发生率（1.0％比0％，P <0.001）。在30天卒中发生率（经股动脉：3.1％，经al动脉：1.6％； P = 0.043），急性肾损伤（经股动脉：9.9％，经radi骨：5.7％； P <0.001）之间，观察到二级访问组之间存在显着差异。和死亡率（经股骨：4.0％，经radi骨：2.4％，P = 0.047）。结论在TAVR手术中使用经radi动脉入路作为次要途径可显着减少血管和出血并发症并改善30天预后。将来需要进行随机研究。经radi骨：1.6％; P = 0.043），急性肾损伤（经股骨：9.9％，经radi骨：5.7％； P <0.001）和死亡率（经股骨：4.0％，经radi骨：2.4％，P = 0.047）。结论在TAVR手术中使用secondary动脉入路作为次要途径可显着减少血管和出血并发症并改善30天预后。将来需要进行随机研究。经radi骨：1.6％; P = 0.043），急性肾损伤（经股骨：9.9％，经radi骨：5.7％； P <0.001）和死亡率（经股骨：4.0％，经radi骨：2.4％，P = 0.047）。结论在TAVR手术中使用secondary动脉入路作为次要途径可显着减少血管和出血并发症并改善30天预后。将来需要进行随机研究。