Major Vascular Complications After Percutaneous Transfemoral Approach for Transcatheter Aortic Valve Implantation in Propensity-Matched Cohort: Impact on Clinical Outcomes and Survival

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OBJECTIVES: Transfemoral transcatheter aortic valve implantation (TAVI) has become the preferred approach for treating aortic stenosis in patients over 70 years. Despite advancements in technology and operator experience, major vascular complications (MVCs) remain a concern, potentially affecting outcomes. This study aimed to assess the incidence, risk factors, and clinical impact of MVCs following transfemoral TAVI using propensity score matching. METHODS: We retrospectively analysed patients who underwent transfemoral TAVI. Patients were divided into 2 groups: patients who developed MVCs (MVC group) and those who did not present the complication (No-MVC group). The primary end-point was the 30-day mortality. A 1:1 propensity score matching was performed, and clinical outcomes were compared at 30 days and up to 2 years. RESULTS: Between 2012 to 2023, a total of 2296 underwent a percutaneous-transfemoral approach. Major vascular complications occurred in 6.6% (n = 151) and were associated with increased transfusion requirement, major bleeding, reinterventions, and longer hospital stays. Female sex, obesity, higher STS score, use of the Manta closure device, and post-implantation balloon valvuloplasty were independently associated with MVCs. The 30-day mortality was similar between groups (P = .723). The long-term survival was lower in the MVC group (P = .016). Two-year survival after propensity score matching did not differ between groups (P = .08). CONCLUSIONS: Major vascular complications after transfemoral transcatheter valve implantation are associated with worse clinical outcomes and reduced long-term survival despite similar at 30-day mortality. Recognizing high-risk patients, optimizing procedural planning, and considering alternative access routes may help reduce vascular complications.

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