2026-04-17T14:44:07Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/81322025-10-24T10:29:51Zcom_2072_378070com_2072_378040col_2072_378092

Transcatheter aortic valve replacement in obese patients: procedural vascular complications with the trans-femoral and trans-carotid access routes Alperi, Alberto McInerney, Angela Modine, Thomas Chamandi, Chekrallah Tafur Soto, Jose Barbanti, Marco Serra García, Vicente Institut Català de la Salut [Alperi A] Quebec Heart & Lung Institute, Laval University, Quebec City, Canada. [McInerney A] Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain. [Modine T] Centre Hospitalier Universitaire de Lille, Lille, France. [Chamandi C] Hôpital européen Georges-Pompidou, Paris, France. [Tafur-Soto JD] The Ochsner Clinical School, Ochsner Medical Center, New Orleans, LA, USA. [Barbanti M] Ferrarotto Hospital, University of Catania, Catania, Italy. [Serra V] Vall d’Hebron Hospital Universitari, Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Vàlvula aòrtica - Estenosi - Cirurgia Persones obeses Cateterisme cardíac - Complicacions ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Cardiac Surgical Procedures::Heart Valve Prosthesis Implantation::Transcatheter Aortic Valve Replacement Other subheadings::Other subheadings::Other subheadings::/adverse effects DISEASES::Pathological Conditions, Signs and Symptoms::Signs and Symptoms::Body Weight::Overweight::Obesity DISEASES::Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases::Aortic Valve Stenosis TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos cardíacos::implantación de prótesis valvulares cardíacas::sustitución valvular aórtica con catéter Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos ENFERMEDADES::afecciones patológicas, signos y síntomas::signos y síntomas::peso corporal::sobrepeso::obesidad ENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::enfermedades de las válvulas cardíacas::estenosis de la válvula aórtica Obesity; Transcarotid; Transfemoral Obesidad; Transcarotídea; Transfemoral Obesitat; Transcaròtida; Transfemoral OBJECTIVES Obesity may increase the risk of vascular complications in transfemoral (TF) transcatheter aortic valve replacement (TAVR) procedures. The transcarotid (TC) approach has recently emerged as an alternative access in TAVR. We sought to compare vascular complications and early clinical outcomes in obese patients undergoing TAVR either by TF or TC vascular access. METHODS Multicentre registry including obese patients undergoing TF- or TC-TAVR in 15 tertiary centres. All patients received newer-generation transcatheter heart valves. For patients exhibiting unfavourable ileo-femoral anatomic characteristics, the TC approach was favoured in 3 centres with experience with it. A propensity score analysis was performed for overcoming unbalanced baseline covariates. The primary end point was the occurrence of in-hospital vascular complications (Valve Academic Research Consortium-2 criteria). RESULTS A total of 539 patients were included, 454 (84.2%) and 85 (15.8%) had a TF and TC access, respectively. In the propensity-adjusted cohort (TF: 442 patients; TC: 85 patients), both baseline and procedural valve-related characteristics were well-balanced between groups. A significant decrease in vascular complications was observed in the TC group (3.5% vs 12% in the TF group, odds ratio: 0.26, 95% CI: 0.07–0.95, P = 0.037). There were no statistically significant differences between groups regarding in-hospital mortality (TC: 2.8%, TF: 1.5%), stroke (TC: 1.2%, TF: 0.4%) and life-threatening/major bleeding events (TC: 2.8%, TF: 3.8%). CONCLUSIONS In patients with obesity undergoing TAVR with newer-generation devices, the TC access was associated with a lower rate of vascular complications. Larger randomized studies are warranted to further assess the better approach for TAVR in obese patients. 2022-09-09T14:54:10Z 2022-09-09T14:54:10Z 2022-06 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Alperi A, Mcinerney A, Modine T, Chamandi C, Tafur-Soto JD, Barbanti M, et al. Transcatheter aortic valve replacement in obese patients: procedural vascular complications with the trans-femoral and trans-carotid access routes. Interact Cardiovasc Thorac Surg. 2022 Jun;34(6):982–9. 1569-9285 https://hdl.handle.net/11351/8132 10.1093/icvts/ivab354 34942005 000756825900001 http://hdl.handle.net/11351/8132 eng Interactive CardioVascular and Thoracic Surgery;34(6) https://doi.org/10.1093/icvts/ivab354 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf Oxford University Press Scientia