AI Article Synopsis

  • Vascular complications are a significant issue for patients undergoing transfemoral transcatheter aortic valve replacement (TAVR), especially those with peripheral artery disease, and the Hostile score has been developed to help assess risk.
  • A study validated the Hostile score by analyzing data from 2,023 TAVR patients, finding that those with higher Hostile scores were more likely to experience vascular complications, particularly non-puncture site issues.
  • The research found that independent predictors of complications included body mass index, use of specific closure devices, and a higher Hostile score, with the score being particularly effective in predicting non-puncture site complications after the procedure.

Article Abstract

Background: Vascular complications remain a major concern in transfemoral transcatheter aortic valve replacement (TAVR). The Hostile score has been proposed to stratify risk in TAVR patients with peripheral artery disease.

Objectives: The authors aimed to assess the validity of the Hostile score in predicting iliofemoral vascular complications after TAVR.

Methods: In a prospective TAVR registry, we validated the Hostile score for the prediction of puncture and non-puncture site vascular complications. This scoring system integrates the extent (number of lesions, lesion length, and minimum lumen diameter) and complexity (tortuosity, calcification, and the presence of obstruction) of iliofemoral atherosclerosis.

Results: Of 2,023 patients who underwent transfemoral TAVR with contemporary devices between March 2014 and June 2022, 106 (5.2%) patients experienced puncture site vascular complications and 28 (1.4%) patients experienced non-puncture site vascular complications. The Hostile score was higher in patients with vascular complications than those without complications (1.00 [Q1-Q3: 0-5.00] vs 1.00 [Q1-Q3: 0-4.00]; P < .001). A higher body mass index (OR: 1.23; 95% CI: 1.04-1.50) and the use of Prostar (OR: 6.03; 95% CI: 2.23-16.30) or MANTA (OR: 6.18; 95% CI: 2.67-14.27) compared with ProGlide were independent predictors of puncture site vascular complications, whereas a higher Hostile score (OR: 1.91; 95% CI: 1.55-2.35) and female sex (OR: 2.69; 95% CI: 1.12-6.42) were independent predictors of non-puncture site vascular complications. The area under the receiver-operating characteristic curves for the prediction of puncture site and non-puncture site vascular complications were 0.554 and 0.829, respectively.

Conclusions: The Hostile score proved useful in predicting non-puncture site vascular complications after TAVR. (SwissTAVI Registry; NCT01368250).

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Source
http://dx.doi.org/10.1016/j.jcin.2024.07.009DOI Listing

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