The Impact of Vascular Access Complications in Patients Undergoing Transcatheter Aortic Valve Replacement

ABSTRACT Background Vascular complications remain a significant concern in transfemoral transcatheter aortic valve replacement (TAVR). Aims Determine the incidence of vascular complications following TAVR and evaluate their impact on short‐ and long‐term clinical outcomes. Methods We conducted a retrospective observational analysis of patients undergoing transfemoral TAVR at a single institution. Patients were stratified into three groups: Group 0 (no perioperative complications), Group 1 (vascular complications), and Group 2 (non‐vascular complications). The primary outcome was early‐ and late‐mortality. Propensity score matching was performed to compare outcomes between Group 0 and Group 1. Results Among 5230 patients, 4391 (84.0%) were in Group 0, 154 (2.9%) in Group 1, and 685 (13.1%) in Group 2. In Group 1, 36.4% experienced intraoperative bleeding requiring intervention, 27.3% had intraoperative limb ischemia or dissection, and 16.2% required postoperative takeback for limb ischemia. In‐hospital mortality was 12/154 (7.8%) in Group 1, compared with 7/4391 (0.2%) in Group 0 and 45/685 (6.6%) in Group 2 ( p < 0.001). Thirty‐day mortality was 16/154 (10.4%) in Group 1 versus 117/4391 (2.7%) in Group 0 and 70/685 (10.2%) in Group 2 ( p < 0.001). Propensity‐matched analysis showed Group 1 had fourfold higher 30‐day mortality (OR 4.02, 95% CI 1.98–8.18, p < 0.001). One‐year mortality was 29/148 (19.6%) for Group 1 compared with 72/592 (12.2%) for Group 0, with 5‐year survival similar between groups (Group 1: 51.1%, Group 0: 50.9%, log‐rank p = 0.214), while unmatched Group 2 had 43.1% 5‐year survival. Conclusion While vascular complications after TAVR are uncommon, they are linked to substantially worse early outcomes, whereas long‐term survival among patients who survive the initial postoperative period remains comparable, emphasizing the critical impact during the early phase.