Critical Lower Limb Ischemia Should Be Taken into Account in TAVR

Courtesy of Dr. Carlos Fava.

Peripheral vascular diseases (PVD) present the same risk factors as aortic stenosis. In consequence, these disorders usually coexist.

The frequency and impact of their various stages on patients undergoing TAVR is yet to be thoroughly assessed.

Read also: “Peripheral Vascular Disease Is Associated to More Events in TAVR”.

This study analyzed 32,044 patients who underwent TAVR between 2007 and 2013. Among them, 3375 (10.5%) experienced PVD. Additionally, within this subgroup, 2721 patients (80.6%) presented intermittent claudication (IC) and 654 (19.4%) experienced critical ischemia (CI).

The PVD group presented more comorbidities and a higher risk score.

Transfemoral access was used in 68.9% of all cases and transapical access was used in the remaining 31.1%.

Read also: “Latest articles about peripheral vascular diseases”.

The in-hospital mortality among patients without PVD, IC, and CI was 6.1%, 8.4%, and 14.7%, respectively (p < 0.001). The rates of stroke, bleeding, and renal insufficiency were higher among patients with PVD, particularly those in the CI subgroup. In a multivariate analysis, CI was a predictor of in-hospital mortality (odds ratio: 1.96; 95% confidence interval: 1.56-2.47; p < 0.001).

The rates of in-hospital stay and need for ventilation were higher among patients in the PVD group with critical ischemia.

Conclusion

In patients undergoing TAVR, the presence of PVD is associated with an increased risk of periprocedural complications, while only critical ischemia predicts in-hospital mortality.

Editorial Comment

PVD entails more vascular compromise, thus relating to higher risks and worse outcomes, particularly in high-risk patients undergoing TAVR.

This study was carried out with first-generation valves, mainly, which may be related to more acute complications for this group. Valves of lower profile and greater group experience will surely set a trend towards decreased complications.

That notwithstanding, we shall always remember that PVD is one of our worst enemies.

Courtesy of Dr. Carlos Fava.

Original title: Prevalence and Impact of Critical Limb Ischaemia on In-Hospital Outcome in Transcatheter Aortic Valve Implantation.

Reference: Nasser M. Malyar, et al. EuroIntervention 2017,13:1282-1288.

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