OR03-9
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
Presenter
Hafiz Muhammad Imran, M.D., Brown University, Providence, RI
Hafiz Muhammad Imran, M.D.1, Phinnara Has, MS1, Nicholas Kassis, M.D.1, Ernie Shippey, MS2, Paul C Gordon, M.D.1, Barry L. Sharaf, M.D.3, Peter A. Soukas, M.D., FSCAI4, Omar N Hyder, M.D.5, Frank Sellke, M.D.1, Afshin Ehsan, M.D.5, Neel Sodha, M.D.1, Amgad Mentias, M.D.6, Islam Y. Elgendy, M.D., FSCAI7, Mohamad Alkhouli, M.D., FSCAI8, J. Dawn Abbott, M.D., FSCAI9, Herb D. Aronow, MD, MPH, FSCAI10 and Marwan Saad, M.D., Ph.D., FSCAI1, (1)Brown University, Providence, RI, (2)Vizient Center for Advanced Analytics, Chicago, IL, (3)Rhode Island Hospital, Providence, RI, (4)Cardiovascular Institute, Providence, RI, (5)Rhode Island Hospital, Cranston, RI, (6)Cleveland Clinic, Cleveland, OH, (7)The University of Kentucky, Lexington, KY, (8)Mayo Clinic College of Medicine and Science, Rochester, MN, (9)Rhode Island Hospital, Barrington, RI, (10)Henry Ford Health, Detroit, MI
Keywords: Intravascular Lithotripsy (IVL), Structural Heart Disease (SHD) and TAVI/TAVR/Aortic Valve
Background:
Transfemoral (TF) access is the preferred approach for patients undergoing transcatheter aortic valve replacement (TAVR). Limited data exist regarding the role of intravascular lithotripsy (IVL) to facilitate TF-TAVR in patients with iliofemoral peripheral artery disease (PAD).
Methods:
The Vizient Clinical Database was queried to select patients who underwent percutaneous TAVR between the time of commercial availability of peripheral IVL (i.e., October 1, 2020) and March 31, 2023. Outcomes in patients in whom IVL was utilized to facilitate TF-TAVR were examined. The primary outcome was successful TF-TAVR. Key secondary outcomes included in-hospital death, vascular complication, need for surgical vascular intervention, and major bleeding, among many others.
Results:
Over the study period, a total of 98,240 patients (mean age 78.4 years, 42.2% women, 87.3% White, mean Elixhauser comorbidity score 4.3) underwent percutaneous TAVR at 333 U.S. hospitals, 915 (0.93%) of whom underwent IVL-TAVR. There was a significant uptrend in IVL-TAVR but frequency remained low (1.3% in 2023). IVL-TAVR group exhibited a higher burden of comorbidities and Elixhauser comorbidity score. TAVR was successfully performed via TF approach in 99.8% of IVL-TAVR patients. Vascular complications, surgical vascular intervention, and major bleeding were 9.6%, 2.4%, and 11.8% in the IVL-TAVR group, respectively.
Conclusions:
In this nationwide retrospective study, IVL was feasible and safe in facilitating TF-TAVR in patients with iliofemoral PAD. Further studies are required to identify anatomic and clinical indications for peripheral IVL use in TAVR patients. 