Surgical cut-down or percutaneous access-which is best for less vascular access complications in transfemoral TAVI?

Abstract

Objective of the present study was to compare VARC-2 access and bleeding complications of a complete percutaneous versus a surgical cut-down approach for transfemoral TAVI "in a real world-all comers" setting. The ideal approach for transfemoral TAVI is still part of a lively debate. Until today, for none of the available techniques superiority could be demonstrated. The present study adds a considerable number of patients to the available experience. The study included 334 consecutive patients, including 199 patients in the percutaneous and 135 patients in the cut-down group. Mean patient's age was 81.4 ± 4.6. Calculated logistic EuroSCORE correlated an intermediate to high surgical risk (17.8% ± 12.3%). Primary study endpoints were vascular access site as well as bleeding complications according the actual VARC-2 criteria. Mean procedure time was significantly shorter in the cut-down group (69 ± 19 min vs. 91 ± 22 min; P < 0.01). Overall rate of VARC-2 access complications were significantly more frequent in the percutaneous group (n = 41/199; 20.6% vs. n = 11/135; 8.1%; P = 0.04); the incidence of major complications did not differ significantly (P = 0.19). VARC-2 bleeding complications were more frequent in the percutaneous group as well (18.1% vs. 4.4%; P = 0.029). Hospital stay differed not significantly (P = 0.214). Hospital mortality was 3.5% in the percutaneous group and 1.5% in the cut-down group (P = n.s.). Surgical cut-down provided a convenient and controlled access, resulting in less access and bleeding complications. Nontheless, major access complication differed not significantly. Both approaches must be seen as complementary techniques. A portfolio containing both techniques is the exclusive way to provide a tailor-made and patient-orientated approach. © 2015 Wiley Periodicals, Inc.