C-83 | Characteristics, Trends, and Outcomes of Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Replacement In the United States: A Nationwide Analysis from the Vizient Clinical Database

Transfemoral (TF) access is the preferred approach fortranscatheter aortic valve replacement (TAVR). Limited data exist regarding the role of intravascular lithotripsy to facilitate TF-TAVR (IVL-TAVR) in patients with iliofemoral peripheral artery disease (PAD). TheVizient Clinical Database was queried for patients who underwent TAVR from commercial availability of peripheral IVL (i.e., October 1, 2020) until November 30, 2023. Outcomes with IVL-TAVR vs non-IVL-TAVR were examined after propensity score matching (PSM) to correct for multiple patient and hospital characteristics. The primary efficacy outcome was successful TF-TAVR, and primary safety outcome was a composite of vascular complications, major bleeding, and need for surgical vascular intervention. Various secondary outcomes were examined. A total of 129,655 patients (mean age 78.4 years, 42.2% women, 87.1% White, mean Elixhauser comorbidity score 4.3) underwent TAVR at 361 U.S. hospitals, 1242 (0.96%) of whom underwent IVL-TAVR. IVL-TAVR group exhibited a higher burden of comorbidities. In a 1:3 PSM analysis (IVL-TAVR n=1204, non-IVL-TAVR n=3458), IVL-TAVR was associated with higher likelihood of successful TF-TAVR (99.7% vs 98.9%, P=0.01), but a higher incidence of composite safety outcome (20.9% vs 13.3%, P<0.001), driven mainly by vascular complications (9.2% vs 2.9%) and surgical vascular intervention (2.4% vs 1.0%), compared with non-IVL-TAVR. No difference in major bleeding was observed between both groups. In-hospital mortality was low in both groups, but slightly higher with IVL-TAVR (1.9% vs 1.2%, P=0.046). No difference was observed in other secondary outcomes including conversion to surgical AVR or alternative access TAVR, stroke, myocardial infarction, or cardiogenic shock. The mean length of stay and total direct cost was higher in the IVL-TAVR group. In this largest-to-date nationwide retrospective study, IVL was effective and safe in facilitating TF-TAVR in patients with iliofemoral PAD. Further studies are required to identify the anatomic and clinical indications and compare outcomes with IVL-TAVR vs alternative access TAVR in patients with iliofemoral PAD.