The Impact of THV Platforms on Transfemoral TAVR in Complex Vascular Access: Insights From the Hostile Registry.

Background
The choice of transcatheter heart valve (THV) platform, including self-expanding valves (SEVs) and balloon-expandable valves (BEVs), may influence outcomes in patients with peripheral artery disease (PAD) undergoing transfemoral transcatheter aortic valve replacement (TAVR). This relationship remains underexplored in high-risk populations with challenging vascular access.Aims
This study assessed the impact of SEVs and BEVs on clinical outcomes in PAD patients, considering hostile score severity.Methods
This sub-analysis of the Hostile Registry included 419 TAVR patients (47% SEVs, 53% BEVs). Outcomes, including all-cause mortality, stroke, vascular complications, and major bleeding were evaluated at 30 days and 1 year. Logistic regression and Cox proportional hazard models assessed associations, with interaction terms exploring the modifying effect of valve type by hostile score severity.Results
No significant differences emerged between SEVs and BEVs for 30-day and 1-year outcomes. However, in SEVs recipients, a high hostile score was associated with worse outcomes, including 1-year all-cause mortality (HR 2.81, p = 0.033), stroke (HR 18.26, p = 0.008), major bleeding (HR 2.49, p = 0.033), and MACCE (HR 4.34, p < 0.001). Interaction terms were not statistically significant, although a trend for MACCE (p = 0.0598) was noted.Conclusions
SEVs and BEVs demonstrated comparable outcomes overall, high hostile score were associated with worse outcomes in the SEV group. Nonetheless, there was a trend suggesting a difference between the two valves in this setting, and further studies are needed to confirm potential valve-specific differences in high-risk populations and to refine personalized valve selection.