Proper Selection Does Make the Difference: A Propensity-Matched Analysis of Percutaneous and Surgical Cut-Down Transfemoral TAVR.

Marco Gennari,Laura Fusini,Mauro Pepi,Antonio L Bartorelli,Giorgio Mastroiacovo,Piero Trabattoni,Marco Agrifoglio,Manuela Muratori,Marta Rigoni,Maurizio Roberto,Gianluca Polvani,Paola Muti,Gloria Tamborini,Franco Fabbiocchi

doi:10.3390/jcm10050909

Abstract

Background. Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosis patients with a wide range of surgical risk. Currently, the common femoral artery is the first choice as the main access route for the procedure. The objective of this observational study is to report our experience on percutaneous and surgical cut-down transfemoral TAVRs comparing the two approaches. Methods. From January 2014 to January 2019, five hundred eleven consecutive patients underwent TAVR for severe symptomatic aortic stenosis. We analyzed only elective transfemoral procedures. After propensity score-matching based on age, sex, EuroSCORE II, mean aortic gradient, and left ventricular ejection fraction, we obtained two homogeneous populations: surgical cut-down (n = 119) and percutaneous (n = 225), which were labeled Group 1 and Group 2, respectively. Results. The main findings were that there were no significant procedural outcome differences between the two groups, but Group 2 patients had a shorter length of hospital stay and were more frequently discharged home. At follow-up, Group 1 patients had lower survival rates. Conclusions. An accurate preoperative assessment of the femoral access is mandatory to achieve satisfactory outcomes with transfemoral TAVRs. Nevertheless, the percutaneous approach allows shorter in-hospital stay and the need for rehabilitation, thus potentially decreasing the costs of the procedure.

Highlights

Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosis patients with a wide range of surgical risk
The aim of this observational study is to report our experience, outcomes, and followup of the transfemoral TAVRs with the currently available devices performed by either a surgical cut-down or a percutaneous approach. This is an observational study of the perioperative and follow-up outcomes of both surgical cut-down and percutaneous transfemoral TAVRs, compared by a propensity score-matching of the two populations
From January 2014 to January 2019, five hundred-eleven patients with severe symptomatic aortic stenosis were treated at our institution with both transfemoral balloonexpandable and self-expanding TAVR by the same surgical group

Summary

Introduction

Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosis patients with a wide range of surgical risk. Surgical cut-down of the common femoral artery may allow better control and repair in case of complications, but it is burdened by all the classical surgical access-related problems [5] such as invasiveness, longer recovery, infection risk, lymphatic or neurological issues, and currently, a fully percutaneous approach with VCDs use is the preferred choice [6]. The aim of this observational study is to report our experience, outcomes, and followup of the transfemoral TAVRs with the currently available devices performed by either a surgical cut-down or a percutaneous approach

Methods

Results

Discussion

Conclusion