Fully percutaneous transfemoral TAVR was associated with a similar risk of vascular complications compared to the open surgical approach (19% vs 22%; P=0.73) but reduced length of stay.
Cohort (n=331)
Does a fully percutaneous approach reduce vascular complications compared to an open surgical approach in patients undergoing transfemoral transcatheter aortic valve replacement?
Fully percutaneous transfemoral TAVR is associated with similar vascular complication rates but shorter length of stay compared to the open surgical approach.
Absolute Event Rate: 19% vs 22%
p-value: p=0.73
BACKGROUND: Vascular complications after transfemoral transcatheter aortic valve replacement are common and associated with significant morbidity and mortality. Little is known about the effect of access approach on vascular complications. METHODS AND RESULTS: Between 2007 and 2013, 331 patients underwent transfemoral transcatheter aortic valve replacement via open surgical (OS) or fully percutaneous (PC) approaches. Patient data and clinical outcomes were collected. Valve Academic Research Consortium-defined vascular complications were noted. Multivariable analysis with propensity matching was performed, and vascular complications, mortality, and length of stay were assessed. One hundred twenty patients were treated with the OS approach and 211 patients via the PC approach. There were fewer major vascular complications (11% versus 20%; P=0.03) and shorter length of stay (7.5 versus 9.9 days; P=0.003) in the PC group when compared with those in the OS group. In multivariable analysis, vascular complications were more likely in women (odds ratio, 2.2; P=0.02) and with increasing differences between sheath outer diameter and minimal artery diameter (overall vascular complications: odds ratio, 1.4; P=0.02 and major vascular complications: odds ratio, 2.0; P<0.001). Propensity-matched analysis demonstrated no difference in vascular complications between the OS and the PC groups (22% versus 19%; P=0.73) but significantly reduced length of stay in the PC group (7.9 versus 10.0 days; P=0.04). CONCLUSIONS: Transfemoral transcatheter aortic valve replacement performed via the PC route is associated with similar risk of vascular complications and significantly lower postprocedural length of stay than the OS route. The degree of sheath oversizing with respect to iliofemoral minimal artery diameter and female sex are associated with vascular complications regardless of access approach.
Kadakia et al. (2014) conducted a cohort in Transfemoral transcatheter aortic valve replacement (n=331). Fully percutaneous (PC) approach vs. Open surgical (OS) approach was evaluated on Vascular complications (propensity-matched) (p=0.73). Fully percutaneous transfemoral TAVR was associated with a similar risk of vascular complications compared to the open surgical approach (19% vs 22%; P=0.73) but reduced length of stay.