BACKGROUND Transfemoral (TF) access is the preferred approach for transcatheter aortic valve replacement (TAVR). Limited data exist regarding the outcomes of intravascular lithotripsy (IVL)-assisted TF TAVR in patients with peripheral artery disease. OBJECTIVES This study sought to examine contemporary characteristics, trends, and outcomes of IVL TAVR in the United States. METHODS The Vizient Clinical Database was queried for patients who underwent percutaneous TAVR between October 1, 2020, and November 30, 2023. Outcomes with IVL TAVR vs non-IVL TAVR were examined after propensity score matching. The primary outcome was a composite of in-hospital death, stroke, vascular complications, surgical vascular intervention, and major bleeding. RESULTS Over the study period, 129,655 patients (mean age of 78.4 years, 42.2% women, 87.1% White) underwent percutaneous TAVR at 361 hospitals, 1,242 (0.96%) of whom underwent IVL TAVR. There was an uptrend in IVL TAVR, but the frequency remained low. IVL TAVR patients had a higher median Elixhauser comorbidity score (5 [Q1-Q3: 4-7] vs 4 [Q1-Q3: 3-6]) compared to non-IVL TAVR. TAVR was completed via the TF approach in 1,238 (99.7%) IVL TAVR patients. In a 3:1 propensity score matching analysis, IVL TAVR was associated with a higher rate of the primary composite outcome (21.9% vs 13.7%; P < 0.001) driven by higher rates of vascular complications, surgical vascular intervention, and major bleeding. In-hospital death and stroke were similar in both groups. CONCLUSIONS In the United States, IVL is increasingly adopted to facilitate TF TAVR. IVL TAVR patients exhibited a higher burden of comorbidities and experienced more complications compared to non-IVL TAVR patients. Further studies are needed to identify appropriate anatomical and clinical use criteria for IVL TAVR and to compare its outcomes vs alternative non-TF TAVR.

中文翻译：

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美国血管内碎石辅助经股动脉经导管主动脉瓣置换术的特征、趋势和结果。


背景经股动脉 （TF） 通路是经导管主动脉瓣置换术 （TAVR） 的首选方法。关于血管内碎石术 （IVL） 辅助 TF TAVR 在外周动脉疾病患者中的结局，数据有限。目的 本研究旨在检查美国 IVL TAVR 的当代特征、趋势和结果。方法 查询 Vizient 临床数据库以获取 2020 年 10 月 1 日至 2023 年 11 月 30 日期间接受经皮 TAVR 的患者。倾向评分匹配后检查 IVL TAVR 与非 IVL TAVR 的结局。主要结局是院内死亡、卒中、血管并发症、手术血管介入和大出血的复合结局。结果 在研究期间，129,655 名患者 （平均年龄 78.4 岁，42.2% 女性，87.1% 白人） 在 361 家医院接受了经皮 TAVR，其中 1,242 名 （0.96%） 接受了 IVL TAVR。IVL TAVR 呈上升趋势，但频率仍然很低。与非 IVL TAVR 患者相比，IVL TAVR 患者的中位 Elixhauser 合并症评分 （5 [Q1-Q3： 4-7] vs 4 [Q1-Q3： 3-6]）。1,238 例 （99.7%） IVL TAVR 患者通过 TF 方法完成 TAVR。在 3：1 倾向评分匹配分析中，IVL TAVR 与较高的主要复合结局发生率相关 （21.9% 对 13.7%;P < 0.001） 由血管并发症、外科血管介入和大出血发生率较高驱动。两组的院内死亡和卒中相似。结论 在美国，IVL 越来越多地被用于促进 TF TAVR。与非 IVL TAVR 患者相比，IVL TAVR 患者表现出更高的合并症负担和更多的并发症。 需要进一步的研究来确定 IVL TAVR 的适当解剖学和临床使用标准，并比较其结局与其他非 TF TAVR 的结局。