RP during TF-TAVR may lower the risk of major vascular events but increase overall complications and bleeding, according to data from the SURF-TAVR registry, published in Clinical Research in Cardiology.

The study included 4,224 TF-TAVR patients treated across 15 centers in Italy and France between January 2020 and August 2023. Centers were classified based on routine use of RP versus no-routine protection (nRP). Propensity score matching adjusted for baseline differences.

Overall vascular complications were higher in RP centers (12.1% vs. 8.3%; p < 0.001), whereas major vascular complications were lower (1.1% vs. 2.4%; p = 0.009). Bleeding events were more frequent in RP centers (9.7% vs. 6.6%; p < 0.001), but major bleeding rates were similar (4.8% vs. 3.8%; p = 0.111).

These results suggest that while RP may protect against severe vascular injury, it could introduce additional procedural risks. Tailoring vascular access strategies and balancing procedural safety with complication risk remain essential in optimizing TF-TAVR outcomes.