Key result
Surgical cutdown for vascular access during TAVR resulted in 0 major vascular complications compared to 10% with percutaneous access (p<0.005).
Why the study?
To reduce vascular complications during transfemoral TAVR, surgical cutdown was selectively used in patients with calcified or small femoral arteries, and this study aimed to review experience with this approach.
Does surgical cutdown prevent major vascular complications in patients undergoing transfemoral TAVR with calcified or small femoral arteries compared to percutaneous access?
Cohort (n=944)
No
Does surgical cutdown prevent major vascular complications in patients undergoing transfemoral TAVR with calcified or small femoral arteries compared to percutaneous access?
Absolute Event Rate: 0% vs 10%
p-value: p=<0.005
Selective surgical cutdown for TAVR access in patients with small or severely calcified femoral arteries safely avoids major vascular complications without increasing procedure time or length of stay.
Surgical cutdown may lower major vascular complications risk; leaves open confirmation in prospective trials.
Background Third-generation transcatheter heart valves (THV) are predominantly implanted through a percutaneous, transfemoral access. To reduce vascular complications, we selectively performed surgical vascular access (cutdown) in patients with particular calcified or small femoral arteries. We aim to review our experience with this approach. Methods All patients who underwent transfemoral transcatheter aortic valve replacement (TAVR) with a third-generation THV at our institution between March 2014 and April 2019 were included in the study. All available computerized tomography studies were reassessed for access vessel diameter and visual graduation of calcifications. Vascular complications are reported according to Valve Academic Research Consortium-2 criteria. Results A total of 944 patients were included. Among them, 879 patients underwent a percutaneous access and 65 patients underwent surgical cutdown. Also, 459 Evolut R/PRO and 420 Sapien 3/ultra were implanted percutaneously and 40 Evolut R/PRO and 25 Sapien 3 were implanted with a surgical cutdown. Patients with surgical cutdown were older (80.0 ± 7.5 vs. 83.8 ± 7.5 years, p < 0.001), had smaller femoral arteries (8.0 ± 1.6 vs. 7.6 ± 1.6 mm, p = 0.034) and more severe vessel calcifications (17.5 vs. 1.0%, p < 0.001). Procedure time was similar for cutdown and percutaneous access (64.0 vs. 64.5 minutes, p = 0.879). With percutaneous access, 80 major vascular complications (10%) occurred, whereas with surgical cutdown, no major vascular complications occurred (p < 0.005). No wound infection occurred after surgical cutdown. The mean length of stay was 8 days in both groups. Conclusion Surgical cutdown for vascular access avoids vascular complications in patients with small or severely calcified femoral arteries.
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Burri et al. (2021) conducted a cohort in Transcatheter aortic valve replacement (n=944). Surgical cutdown vs. Percutaneous access was evaluated on Major vascular complications (p=<0.005). Surgical cutdown for vascular access during TAVR resulted in 0 major vascular complications compared to 10% with percutaneous access (p<0.005).
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