Outcomes of transcatheter aortic valve replacement according to femoral or non-femoral peripheral vascular access site: A propensity-matched comparison from the French TAVI Registry

Femoral access is currently the preferred approach for TAVI procedures. However, it is not feasible in all cases and alternative access sites, peripheral and transthoracic have emerged. To compare femoral to non-femoral peripheral vascular access site in propensity matched group. Using data from the national prospective French registry in France – the France TAVI registry – we compared the characteristics and outcomes of TAVI procedures according to whether they were performed through a femoral or a non-femoral peripheral (transcarotid or transaxillary), with a propensity score-based matching of patients with femoral and non-femoral peripheral interventions. Among 13.157 patients included in the France TAVI registry, 83.9% underwent a femoral TAVI, 6.7% a non-femoral peripheral vascular TAVI, and 9.4% transthoracic TAVI. Patients in non-femoral peripheral access were more severe (mean logistic Euroscore 17.3 vs. 19.7, 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 complications according to access site, except for a twice-lower rate of vascular-access related complications in the non-femoral peripheral vascular approach (OR 0.56 (0.32–0.96), P = 0.03 after adjustment to the prosthesis type). There was no difference in short or long term mortality rates. Compared to femoral approach, non-femoral peripheral TAVI is associated with a similar outcome except for a twice-lower rate to access site-related complications. It should be considered more routinely as an alternative to femoral approach.