BACKGROUND Femoral access is the gold standard for transcatheter aortic valve replacement (TAVR). Guidelines recommend reconsidering surgery when this access is not feasible. However, alternative peripheral accesses exist, although they have not been accurately compared with femoral access. OBJECTIVES This study compared nonfemoral peripheral (n-FP) TAVR with femoral TAVR. METHODS Using the data from the national prospective French registry (FRANCE TAVI [French Transcatheter Aortic Valve Implantation]), this study compared the characteristics and outcomes of TAVR procedures according to whether they were performed through a femoral or a n-FP access, using a pre-specified propensity score-based matching between groups. Subanalysis during 2 study periods (2013 to 2015 and 2016 to 2017) and among low/intermediate-low and intermediate-high/high volume centers were performed. RESULTS Among 21,611 patients, 19,995 (92.5%) underwent femoral TAVR and 1,616 (7.5%) underwent n-FP TAVR (transcarotid, n = 914 or trans-subclavian, n = 702). Patients in the n-FP access group had more severe disease (mean logistic EuroSCORE 19.95 vs. 16.95; p < 0.001), with a higher rate of peripheral vascular disease, known coronary artery disease, chronic pulmonary disease, and renal failure. After matching, there was no difference in the rate of post-procedural death and complications according to access site, except for a 2-fold lower rate of major vascular complications (odds ratio: 0.45; 95% confidence interval: 0.21 to 0.93; p = 0.032) and unplanned vascular repairs (odds ratio: 0.41; 95% confidence interval: 0.29 to 0.59; p < 0.001) in those who underwent n-FP access. The comparison of outcomes provided similar results during the second study period and in intermediate-high/high volume centers. CONCLUSIONS n-FP TAVR is associated with similar outcomes compared with femoral peripheral TAVR, except for a 2-fold lower rate of major vascular complications and unplanned vascular repairs. n-FP TAVR may be favored over surgery in patients who are deemed ineligible for femoral TAVR and may be a safe alternative when femoral access risk is considered too high.

中文翻译：

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经导管主动脉瓣置换术的股骨与非股骨外周通路

背景股骨通路是经导管主动脉瓣置换术（TAVR）的金标准。当这种通路不可行时，指南建议重新考虑手术。然而，存在替代的外周通路，尽管它们尚未与股骨通路进行准确比较。目的 本研究比较了非股骨外周 (n-FP) TAVR 与股骨 TAVR。方法 使用来自法国国家前瞻性登记处（FRANCE TAVI [法国经导管主动脉瓣植入术]）的数据，本研究比较了 TAVR 手术的特征和结果，根据它们是通过股骨还是 n-FP 通路进行，使用组之间预先指定的基于倾向得分的匹配。在 2 个研究期间（2013 年至 2015 年和 2016 年至 2017 年）以及低/中低和中高/高容量中心之间进行了子分析。结果 在 21,611 名患者中，19,995 (92.5%) 名接受了股骨 TAVR，1,616 (7.5%) 名接受了 n-FP TAVR（经颈动脉，n = 914 或经锁骨下，n = 702）。n-FP 通路组的患者疾病更严重（平均逻辑逻辑 EuroSCORE 19.95 与 16.95；p < 0.001），外周血管疾病、已知冠状动脉疾病、慢性肺病和肾功能衰竭的发生率更高。匹配后，除了主要血管并发症的发生率低 2 倍（优势比：0.45；95% 置信区间：0.21 至 0.93；p = 0.032）和计划外的血管修复（比值比：0。41; 95% 置信区间：0.29 到 0.59；p < 0.001) 在那些接受 n-FP 访问的人中。结果的比较在第二个研究期间和中高/高容量中心提供了类似的结果。结论 与股骨外周 TAVR 相比，n-FP TAVR 与类似的结果相关，除了主要血管并发症和计划外血管修复的发生率低 2 倍。对于被认为不适合进行股骨 TAVR 的患者，n-FP TAVR 可能比手术更受欢迎，并且当认为股骨通路风险过高时，n-FP TAVR 可能是一种安全的选择。结论 与股骨外周 TAVR 相比，n-FP TAVR 与类似的结果相关，除了主要血管并发症和计划外血管修复的发生率低 2 倍。对于被认为不适合进行股骨 TAVR 的患者，n-FP TAVR 可能比手术更受欢迎，并且当认为股骨通路风险过高时，n-FP TAVR 可能是一种安全的选择。结论 与股骨外周 TAVR 相比，n-FP TAVR 与类似的结果相关，除了主要血管并发症和计划外血管修复的发生率低 2 倍。对于被认为不适合进行股骨 TAVR 的患者，n-FP TAVR 可能比手术更受欢迎，并且当认为股骨通路风险过高时，n-FP TAVR 可能是一种安全的选择。