Major vascular complications occurred in 6.6% of patients and were associated with lower long-term survival despite similar 30-day mortality rates (p = 0.723).
Do major vascular complications after transfemoral TAVI impact 30-day mortality and long-term survival?
Major vascular complications after transfemoral TAVI are associated with increased morbidity but do not significantly impact 30-day mortality or 2-year survival after propensity matching.
Abstract OBJECTIVES Transfemoral transcatheter aortic valve implantation has become the preferred approach for treating aortic stenosis in patients over 70 years. Despite advancements in technology and operator experience, major vascular complications remain a concern, potentially affecting outcomes. This study aimed to assess the incidence, risk factors, and clinical impact of major vascular complications following transfemoral transcatheter aortic valve implantation using propensity score matching. METHODS We retrospectively analyzed patients who underwent transfemoral transcatheter aortic valve implantation. Patients were divided in two groups: patients occurred major vascular complications (MVC group) and those who did not present the complication (No-MVC group). The primary end-point was the 30-day mortality. A 1:1 propensity score matching was performed, and clinical outcomes were compared at 30 days and up to 2 years. RESULTS Between 2012 to 2023, a total of 2,296 underwent a percutaneous-transfemoral approach. Major vascular complications occurred in 6.6% (n = 151) and were associated with increased transfusion requirement, major bleeding, reinterventions, and longer hospital stays. Female sex, obesity, higher STS score, use of the Manta closure device, and post-implantation balloon valvuloplasty were independently associated with major vascular complications. The 30-day mortality was similar between groups (p = 0.723). The long-term survival was lower in the MVC group (p = 0.016). Two-year survival after propensity score matching did not differ between groups (p = 0.08). CONCLUSIONS Major vascular complications after transfemoral transcatheter valve implantation are associated with worse clinical outcomes and reduced long-term survival despite similar at 30-day mortality. Recognizing high-risk patients, optimizing procedural planning, and considering alternative access routes may help reduce vascular complications.
Eid et al. (2026) studied this question. Major vascular complications occurred in 6.6% of patients and were associated with lower long-term survival despite similar 30-day mortality rates (p = 0.723).