Impact of Iliofemoral Disease on Post TAVR Clinical Outcomes: HOSTILE Score Validation

At present, transcatheter aortic valve replacement (TAVR) has been shown safe and effective for treating severe symptomatic aortic stenosis in high-surgical-risk patients. Moreover, its use is expanding to those with intermediate and low risk. However, vascular complications remain the most frequent issue in transfemoral-access TAVR. This is why proper anatomical evaluation of the iliofemoral tree is crucial.

The HOSTILE score was recently developed to quantify atherosclerosis and assess the risk of complications in patients with peripheral artery disease undergoing TAVR. It integrates both the extent (number of lesions, lesion length, and minimum lumen diameter) and the complexity (tortuosity, calcification, and obstruction) of the iliofemoral arterial tree.

The aim of this prospective registry was to validate the HOSTILE score as a predictor of vascular complications after TAVR. Of the 2,023 patients undergoing transfemoral TAVR between March 2014 and June 2022, 106 (5.2%) experienced vascular complications at the puncture site, and 28 (1.4%) had complications outside the puncture site. Patient mean age was 81, average STS score was 3.5, and 49.1% of participants were women. In most cases, balloon-expandable valves were used, and the most commonly employed percutaneous closure device was the ProGlide.

The HOSTILE score was significantly higher in patients who experienced vascular complications vs those who did not (P < 0.001). A higher body mass index (OR: 1.23; 95% CI: 1.04-1.50) and the use of Prostar (OR: 6.03; 95% CI: 2.23-16.30) or MANTA devices (OR: 6.18; 95% CI: 2.67-14.27), vs ProGlide, were independent predictors of complications at the puncture site. Additionally, higher HOSTILE scores (OR: 1.91; 95% CI: 1.55-2.35) and female sex (OR: 2.69; 95% CI: 1.12-6.42) were associated with an increased risk of vascular complications outside the puncture site.

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The area under the curve (AUC) for predicting vascular complications at the puncture site resulted 0.554, and 0.829 for complications outside the puncture site.

Conclusion

The HOSTILE score is useful for predicting vascular complications outside the puncture site after TAVR. A comprehensive approach is necessary to further reduce post-procedural access-related vascular complications.

Original Title: Impact of Severity and Extent of Iliofemoral Atherosclerosis on Clinical Outcomes in Patients Undergoing TAVR.

Reference: Masaaki Nakas MD et al JACC Cardiovasc Interv 2024.