Impact of Severity and Extent of Iliofemoral Atherosclerosis on Clinical Outcomes in Patients Undergoing TAVR

JACC Cardiovasc Interv. 2024 Oct 28;17(20):2353-2363. doi: 10.1016/j.jcin.2024.07.009. Epub 2024 Oct 9.

Abstract

Background: Vascular complications remain a major concern in transfemoral transcatheter aortic valve replacement (TAVR). The Hostile score has been proposed to stratify risk in TAVR patients with peripheral artery disease.

Objectives: The authors aimed to assess the validity of the Hostile score in predicting iliofemoral vascular complications after TAVR.

Methods: In a prospective TAVR registry, we validated the Hostile score for the prediction of puncture and non-puncture site vascular complications. This scoring system integrates the extent (number of lesions, lesion length, and minimum lumen diameter) and complexity (tortuosity, calcification, and the presence of obstruction) of iliofemoral atherosclerosis.

Results: Of 2,023 patients who underwent transfemoral TAVR with contemporary devices between March 2014 and June 2022, 106 (5.2%) patients experienced puncture site vascular complications and 28 (1.4%) patients experienced non-puncture site vascular complications. The Hostile score was higher in patients with vascular complications than those without complications (1.00 [Q1-Q3: 0-5.00] vs 1.00 [Q1-Q3: 0-4.00]; P < .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 (OR: 6.18; 95% CI: 2.67-14.27) compared with ProGlide were independent predictors of puncture site vascular complications, whereas a higher Hostile score (OR: 1.91; 95% CI: 1.55-2.35) and female sex (OR: 2.69; 95% CI: 1.12-6.42) were independent predictors of non-puncture site vascular complications. The area under the receiver-operating characteristic curves for the prediction of puncture site and non-puncture site vascular complications were 0.554 and 0.829, respectively.

Conclusions: The Hostile score proved useful in predicting non-puncture site vascular complications after TAVR. (SwissTAVI Registry; NCT01368250).

Keywords: Hostile score; aortic stenosis; iliofemoral vascular complication; transcatheter aortic valve replacement.

Publication types

  • Multicenter Study
  • Observational Study
  • Validation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery
  • Catheterization, Peripheral* / adverse effects
  • Decision Support Techniques
  • Female
  • Femoral Artery* / diagnostic imaging
  • Humans
  • Iliac Artery* / diagnostic imaging
  • Iliac Artery* / physiopathology
  • Iliac Artery* / surgery
  • Male
  • Peripheral Arterial Disease* / diagnostic imaging
  • Peripheral Arterial Disease* / therapy
  • Predictive Value of Tests*
  • Prospective Studies
  • Punctures*
  • Registries*
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index*
  • Time Factors
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Transcatheter Aortic Valve Replacement* / instrumentation
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT01368250