Key result
Percutaneous transfemoral TAVR is linked to ~39% lower all-cause mortality versus surgical cut-down.
Why the study?
The study was conducted to compare outcomes between percutaneous and surgical cut-down access approaches in patients undergoing transfemoral TAVR.
Does percutaneous transfemoral TAVR improve clinical outcomes compared to surgical cut-down in patients with severe symptomatic aortic stenosis?
Observational (n=344)
No
Does percutaneous transfemoral TAVR improve clinical outcomes compared to surgical cut-down in patients with severe symptomatic aortic stenosis?
Percutaneous transfemoral TAVR is associated with shorter hospital stays and improved survival compared to surgical cut-down, supporting its use as the preferred access strategy when anatomically feasible.
Answers are grounded in this paper and cite their sources.
May support percutaneous access for lower mortality and shorter stay; leaves open randomized confirmation in severe aortic stenosis.
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.
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Gennari et al. (2021) conducted an observational in Severe symptomatic aortic stenosis (n=344). Percutaneous transfemoral TAVR vs. Surgical cut-down transfemoral TAVR was evaluated on All-cause mortality (HR 0.61, 95% CI 0.40-0.94, p=0.03). Percutaneous transfemoral TAVR was associated with a 39% reduction in the hazard of all-cause mortality (HR 0.61) and a shorter hospital stay compared to the surgical cut-down approach.
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