Vascular Complications in Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices

Background: Vascular complications (VCs) remain a major concern after transcatheter aortic valve replacement (TAVR). However, their occurrence in patients treated with newer generation devices has been scarcely studied. Therefore, the aim of this study was to determine the incidence, management, predictors, and clinical impact of VCs in patients undergoing TAVR with contemporary devices. Methods: Multicenter study including 8815 patients that underwent transfemoral TAVR. VCs were classified based on the Valve Academic Research Consortium-3 criteria. Baseline, procedural, and follow-up data were prospectively collected in a dedicated database. Results: VCs occurred in 1464 patients (16.5%), being major and minor in 44.7% and 55.3% of cases, respectively, and most of them related to primary access (87%). Vascular injury (75.2%) and device closure failure (21.2%) were the most predominant subtypes. Major VCs were independently associated with a substantial increase in 1-year mortality (hazard ratio [HR] 2.33, 95% confidence interval [CI] 1.92-2.82, P = 0.001). However, this association was absent in minor VCs, even if an unplanned intervention occurred. Female sex, dual-antiplatelet therapy, access-related anatomic factors, and use of large plug-based vascular closure were associated with an increased risk of major VCs (P < 0.05 for all), with echocardiography-guided access and secondary radial access emerging as protective factors (P < 0.01 for all). Conclusions: VCs persist as a major issue in patients undergoing TAVR with contemporary devices, with multiple modifiable factors determining a higher risk. Major, but not minor VCs were associated with poorer short- and long-term survival. Given their negative impact on clinical outcomes, every effort should be made to minimize the occurrence of VCs after TAVR.