Post-Transcatheter Aortic Valve Replacement (TAVR) Vascular Complications: Femoral Artery Minimal Surgical Access Versus Percutaneous Approach.

Abstract

Percutaneous transfemoral access approach for the transcatheter aortic valve implantation (TAVI) is still associated with significant vascular complications. Hence, evaluation of best techniques for the reduction of vascular injury via the femoral access remains a key subject of research. We report on a single centre's experience with TAVI performed via the Femoral Artery Minimal Surgical Access (MSA) and percutaneous approach (PC). The primary endpoints were to evaluate the incidents of vascular complications by comparing the MSA versus the PC approach according to the VARC-2 criteria. The secondary endpoint included the impact of vascular complications on the in-hospital 30-day mortality and morbidity. Between June 2010 and September 2020, two hundred and thirty-seven consecutive patients who underwent TAVI for severe symptomatic aortic stenosis in our department were divided into two groups: patients treated using the femoral artery minimal surgical access (n = 173), and patients treated using the percutaneous approach (n = 64). Overall rate of access site complications according the VARC-2 were significantly more frequent in the percutaneous cohort (n = 12/64, 18.8% vs n = 2/173, 1.1%, p = 0.0012). The minor access complications including haematoma, bleeding, aneurysm, dissection, stenosis, seroma and infection were more frequent in the PC group (n = 8/64, 12.5% vs n = 2/173, 1.1%, p < 0.001). There were no major access site complications and hospital deaths in the MSA group, which was statistically significant (p < 0.001). Major access complications (n = 4, 6.3%, p < 0.001) and hospital death (n = 2, 3.1%, p < 0.001) were found in the PC cohort. The minimal surgical access approach provided direct and controlled access and significantly reduced the incidence of access site vascular complications in our TAVI patients. It also significantly reduced the in-hospital vascular-related mortality and morbidity. Though both approaches are complementary to each other, minimal surgical access approach would be a better choice for a calcified or tortuous femoral artery, and for a relatively small femoral artery diameter.