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Catheter Cardiovasc Interv. 2018 Jun;91(7):1354-1362. doi: 10.1002/ccd.27377. Epub 2017 Oct 10.

Comparison of outcomes with surgical cut-down versus percutaneous transfemoral transcatheter aortic valve replacement: TAVR transfemoral access comparisons between surgical cut-down and percutaneous approach.

Author information

1
Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest Baptist Medical Center, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, North Carolina, 27157.
2
Departments of Cardiothoracic Surgery, Wake Forest Baptist Medical Center, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, North Carolina, 27157.

Abstract

OBJECTIVES:

The objective is to compare the short-term (30 days) and late (12 months) vascular adverse events in patients undergoing transfemoral (TF)-transcatheter aortic valve replacement (TAVR) by surgical cut-down (SC) vs. percutaneous (PC) approaches.

BACKGROUND:

Programs continue to utilize both approaches in TF-TAVR. There are limited data comparing outcomes by SC vs. PC approaches and long-term effects of endovascular intervention facilitated hemostasis on late vascular adverse events.

METHODS:

A total of 146 men and women aged 79.7 ± 10.0 years with severe aortic stenosis deemed extreme or high risk for surgery underwent TAVR via TF access. 61 had SC and 85 had PC approaches. Valve Academic Research Consortium (VARC-2) outcomes were assessed at an average of 12.1 months after TAVR.

RESULTS:

Hospital length of stay (LOS) post-TAVR was shorter for the PC group compared to the SC group (5.1 ± 3.9 vs. 8.2 ± 6.6 days; P < 0.001). More patients were discharged directly to home in the PC than the SC group (85.9% vs. 68.9%, P < 0.05). At 30 days, there were 13/61 (21.3%) and 16/85 (18.8%; P < 0.05) of any vascular events, and 2/61 (3.3%) and 2/85 (2.4%; P = 0.73) major vascular events in the SC and PC groups, respectively. There was no difference in all-cause mortality between the SC (14/61; 23%) and PC groups [17/85 (20%); P = 0.34]. There was no difference in any [4/33 (12%) vs. 3/43 (7%); P = 0.84] or major vascular adverse events [1/33 (3%) vs. 1/43 (2%); P = 0.79] in subjects that underwent adjunctive endovascular intervention compared to those who did not, respectively. There were no statistically significant univariate or multivariate predictors of any vascular event at 12 months when comparing SC to PC groups.

CONCLUSION:

For TF TAVR, the PC approach, when compared to the SC approach, is associated with a shorter hospital LOS and higher rate of direct discharge to home with similar risk of vascular complications, late vascular adverse events, and all-cause mortality at 12 months.

KEYWORDS:

Transcatheter valve implantation; aortic valve disease percutaneous intervention; comparative effectiveness/patient centered outcomes research; vascular complications

PMID:
29024382
DOI:
10.1002/ccd.27377
[Indexed for MEDLINE]

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