Cut-down outperforms complete percutaneous transcatheter valve implantation.
Background The ideal approach for transfemoral transcatheter aortic valve implantation is still widely debated. The objective of this study was to compare access and bleeding complications of complete percutaneous versus the surgical cut-down approach for transfemoral transcatheter aortic valve implantation. Methods The study included 667 consecutive patients from November 2008 to December 2016, 466 in the percutaneous group and 201 in the cut-down group. There were no significant differences in baseline characteristics between the 2 groups. Primary study endpoints were vascular access site and bleeding complications according to the Valve Academic Research Consortium II criteria. Results Mean procedure time was shorter in the cut-down group: 93.5 ± 22.0 (percutaneous) vs. 69 ± 19 min (cut-down), p < 0.001. The rate of access complications was higher in the percutaneous group: 20.4% (95/466) vs. 8.5% (17/201), p = 0.037; with predominantly minor complications in the percutaneous cohort: 14.4% (67/466) vs. 2.5% (5/201), p = 0.04. Bleeding complications were more frequent in the percutaneous group: 21.9% (102/466) vs. 4.5% (9/201), p = 0.01. Hospital mortality was 5.2% in the percutaneous group and 1.9% in the cut-down group ( p = 0.075). Conclusions Surgical cut-down provided controlled access and resulted in fewer access site and bleeding complications. Nonetheless, major access complications were not significantly different between the two cohorts. The two approaches must be seen as complementary techniques. A portfolio containing both techniques is the only way to provide a tailor-made and patient-orientated approach ensuring the safest access based on the individual vessel condition.
['Mach|Markus|M|', 'Wilbring|Manuel|M|', 'Winkler|Bernhard|B|', 'Alexiou|Konstantin|K|', 'Kappert|Utz|U|', 'Delle-Karth|Georg|G|', 'Grabenwöger|Martin|M|', 'Matschke|Klaus|K|']
D000368:Aged D000369:Aged, 80 and over D016063:Blood Loss, Surgical D002406:Catheterization, Peripheral D005260:Female D005263:Femoral Artery D017052:Hospital Mortality D006801:Humans D008297:Male D061646:Operative Time D019106:Postoperative Hemorrhage D011677:Punctures D012189:Retrospective Studies D012307:Risk Factors D013997:Time Factors D065467:Transcatheter Aortic Valve Replacement D016896:Treatment Outcome D014656:Vascular Surgical Procedures
Aortic valve Catheterization Femoral artery Heart valve prosthesis implantation Hemorrhage Vascular surgical procedures peripheral