Palmerini, TullioTullioPalmeriniSaia, FrancescoFrancescoSaiaKim, Won-KeunWon-KeunKimRenker, MatthiasMatthiasRenkerIadanza, AlessandroAlessandroIadanzaFineschi, MassimoMassimoFineschiBruno, Antonio GiulioAntonio GiulioBrunoGhetti, GabrieleGabrieleGhettiVanhaverbeke, MaartenMaartenVanhaverbekeSøndergaard, LarsLarsSøndergaardDe Backer, OleOleDe BackerRomagnoli, EnricoEnricoRomagnoliBurzotta, FrancescoFrancescoBurzottaTrani, CarloCarloTraniAdrichem, RikRikAdrichemVan Mieghem, Nicolas MNicolas MVan MieghemNardi, ElenaElenaNardiChietera, FrancescoFrancescoChieteraOrzalkiewicz, MateuszMateuszOrzalkiewiczTomii, DaijiroDaijiroTomiiPilgrim, ThomasThomasPilgrimAranzulla, Tiziana ClaudiaTiziana ClaudiaAranzullaMusumeci, GiuseppeGiuseppeMusumeciAdam, MattiMattiAdamMeertens, Max MMax MMeertensTaglieri, NevioNevioTaglieriMarrozzini, CinziaCinziaMarrozziniAlvarez Covarrubias, Hector AlfonsoHector AlfonsoAlvarez CovarrubiasJoner, MichaelMichaelJonerNardi, GiuliaGiuliaNardiDi Muro, Francesca MariaFrancesca MariaDi MuroDi Mario, CarloCarloDi MarioLoretz, LuccaLuccaLoretzToggweiler, StefanStefanToggweilerGallitto, EnricoEnricoGallittoGargiulo, MauroMauroGargiuloTesta, LucaLucaTestaBedogni, FrancescoFrancescoBedogniBerti, SergioSergioBertiAncona, Marco BMarco BAnconaMontorfano, MatteoMatteoMontorfanoLeone, AlessandroAlessandroLeoneSavini, CarloCarloSaviniPacini, DavideDavidePaciniGmeiner, JonasJonasGmeinerBraun, DanielDanielBraunNerla, RobertoRobertoNerlaCastriota, FaustoFaustoCastriotaDe Carlo, MarcoMarcoDe CarloPetronio, Anna SoniaAnna SoniaPetronioBarbanti, MarcoMarcoBarbantiCosta, GiulianoGiulianoCostaTamburino, CorradoCorradoTamburinoLeone, Pier PasqualePier PasqualeLeoneReimers, BernhardBernhardReimersStefanini, GiulioGiulioStefaniniSudo, MitsumasaMitsumasaSudoNickenig, GeorgGeorgNickenigPiva, TommasoTommasoPivaScotti, AndreaAndreaScottiLatib, AzeemAzeemLatibVercellino, MatteoMatteoVercellinoPorto, ItaloItaloPortoCodner, PabloPabloCodnerKornowski, RanRanKornowskiBartorelli, Antonio LAntonio LBartorelliTarantini, GiuseppeGiuseppeTarantiniFraccaro, ChiaraChiaraFraccaroAbdel-Wahab, MohamedMohamedAbdel-WahabGrube, EberhardEberhardGrubeGalié, NazzarenoNazzarenoGaliéStone, Gregg WGregg WStone2024-10-252024-10-252023-02-27https://boris-portal.unibe.ch/handle/20.500.12422/164622BACKGROUND The optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined. OBJECTIVES This study sought to compare clinical outcomes with transfemoral access (TFA), transthoracic access (TTA), and nonthoracic transalternative access (TAA) in TAVR patients with severe PAD. METHODS Patients with PAD and hostile femoral access (TFA impossible, or possible only after percutaneous treatment) undergoing TAVR at 28 international centers were included in this registry. The primary endpoint was the propensity-adjusted risk of 30-day major adverse events (MAE) defined as the composite of all-cause mortality, stroke/transient ischemic attack (TIA), or main access site-related Valve Academic Research Consortium 3 major vascular complications. Outcomes were also stratified according to the severity of PAD using a novel risk score (Hostile score). RESULTS Among the 1,707 patients included in the registry, 518 (30.3%) underwent TAVR with TFA after percutaneous treatment, 642 (37.6%) with TTA, and 547 (32.0%) with TAA (mostly transaxillary). Compared with TTA, both TFA (adjusted HR: 0.58; 95% CI: 0.45-0.75) and TAA (adjusted HR: 0.60; 95% CI: 0.47-0.78) were associated with lower 30-day rates of MAE, driven by fewer access site-related complications. Composite risks at 1 year were also lower with TFA and TAA compared with TTA. TFA compared with TAA was associated with lower 1-year risk of stroke/TIA (adjusted HR: 0.49; 95% CI: 0.24-0.98), a finding confined to patients with low Hostile scores (Pinteraction = 0.049). CONCLUSIONS Among patients with PAD undergoing TAVR, both TFA and TAA were associated with lower 30-day and 1-year rates of MAE compared with TTA, but 1-year stroke/TIA rates were higher with TAA compared with TFA.enalternative access critical patient femoral access transcatheter aortic valve replacement600 - Technology::610 - Medicine & healtharticle10.48350/1794073685865910.1016/j.jcin.2022.12.009