The NORTh Europe HOStile access TAVI (NORTHOSTAVI) registry

Joelle Kefer^1*Yusuke Kobari²Rachid Briki³Christophe Dubois⁴Frederic De Roeck⁵Emmanuel De Cock⁶Charles Pirlet⁷Adel Aminian⁸Julie Colas-Florial⁹Maarten Vanhaverbeke¹⁰Antoine Guédès¹¹Yoann Bataille¹²Amaury Sogorb¹³Kees Van Bergeijk¹⁴Céline Bugli¹⁵Frederic Maes¹⁶Johan Bosmans⁵Ian Buysschaert⁶Liesbeth Rosseel⁹Bert Vandeloo¹⁷Joanna Wykrzykowska¹⁴Ole De Backer²

• ¹Cliniques Universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium
• ²The Heart Center, Righospitalet, Copenhagen, Denmark
• ³Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
• ⁴UZ Leuven, Leuven, Belgium
• ⁵Universiteit Antwerpen, Antwerp, Belgium
• ⁶AZ Sint-Jan Brugge AV, Bruges, Belgium
• ⁷Centre Hospitalier Regional de la Citadelle, Liège, Belgium
• ⁸Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
• ⁹AZORG Hartcentrum, Aalst, Belgium
• ¹⁰AZ Delta vzw, Roeselare, Belgium
• ¹¹CHU UCL Namur, Yvoir, Belgium
• ¹²Jessa Ziekenhuis vwz, Hasselt, Belgium
• ¹³Vrije Universiteit Brussel - Brussels Health Campus, Brussels, Belgium
• ¹⁴Universitair Medisch Centrum Groningen Afdeling Cardiologie, Groningen, Netherlands
• ¹⁵SMCS (Plateforme Technologique de Support en Méthodologie et Support Statistique), UCLouvain, Belgium, Brussels, Belgium
• ¹⁶Cliniques universitaires Saint-Luc, Brussels, Belgium
• ¹⁷Universitair Ziekenhuis Brussel, Brussels, Belgium

Background-Aims. Comparisons between alternative access routes for transcatheter aortic valve implantation (TAVI) in patients with hostile vascular access are scarce. This study aimed to perform a head-to-head comparison of various techniques (percutaneous transaxillary [P-TAx], surgically-assisted transaxillary [S-TAx], transcarotid [TCar], percutaneous transluminal angioplasty-assisted transfemoral [PTA-TF], transbrachiocephalic [TBra], and transcaval [TCav]) with respect to the 30-day outcome of patients undergoing TAVI. Methods. NORTHOSTAVI (NORTh Europe HOStile access TAVI) was an international registry that included patients undergoing TAVI via various endovascular transarterial access routes in Northern European countries. The primary endpoint was the adjusted 30-day rate of composite overall mortality, disabling stroke, main access site-related major vascular complications, and major bleeding according to VARC-3 criteria. Results. In total, 531 patients were enrolled in the study across 14 centers. The main access routes were TCar (N=183, 35%), P-TAx (N=153, 29%), S-TAx (N=79, 15%), and PTA-TF (N=76, 14%), while TBra and TCav were used in 23 (4%) and 17 (3%) patients, respectively. Technical success was achieved in 95% of cases, 30-day overall and event-free survival rates were 97% and 91%, respectively, similar between groups. P-TAx, but not S-TAx or PTA-TF, was associated with an increased adjusted risk of overall stroke (adjusted OR: 4.21; 95%CI: 1.129-15.747; p=0.003) compared to TCar. PTA-TF was associated with an increased adjusted risk of main access site-related major vascular complications (adjusted OR: 7.71; 95%CI: 1.367-43.554; p=0.02) compared to TCar. Conclusions. The NORTHOSTAVI registry showed that in patients with hostile iliofemoral anatomy, TAVI via various endovascular transarterial access route is efficient and safe.