Comparison of outcomes with surgical cut‐down versus percutaneous transfemoral transcatheter aortic valve replacement: TAVR transfemoral access comparisons between surgical cut‐down and percutaneous approach

Abstract

For TF TAVR, the PC approach, when compared to the SC approach, is associated with a shorter hospital LOS and higher rate of direct discharge to home with similar risk of vascular complications, late vascular adverse events, and all-cause mortality at 12 months.

Impact of percutaneous femoral arteriotomy closure using the MANTATM device on vascular and bleeding complications after transcatheter aortic valve replacement

“…The conventional alternative, namely, fully percutaneous suture‐based vascular closure devices are by contrast associated with vascular injury, bleeding and risk of unsuccessful closure. Observational and randomized comparison, however, have described similar clinical outcomes for both techniques . The increased frequency of major bleeding complications with Prostar‐XL seen in our cohort, reflected also by a greater fall in hemoglobin, supports a role for this novel VCD in TAVR practice.…”

Minimalist approach for transcatheter aortic valve replacement

“…For percutaneous approach, structural interventionists use pre-closure technique with two Perclose ProGlide or Prostar® XL devices Abbott Vascular, Santa Clara, CA, USA). 37 Percutaneous approach has shown similar in-hospital or 30-day mortality rates compared with surgical cutdown approach in several reports. [36][37][38][39][40][41] Vascular complications were also compared between the two approaches, demonstrating varying incidence rates across studies ranging from 2.4% to 27.1% for major vascular complications when the percutaneous approach is used.…”

“…37 Percutaneous approach has shown similar in-hospital or 30-day mortality rates compared with surgical cutdown approach in several reports. [36][37][38][39][40][41] Vascular complications were also compared between the two approaches, demonstrating varying incidence rates across studies ranging from 2.4% to 27.1% for major vascular complications when the percutaneous approach is used. 40 The wide variation is due to discrepancy regarding definition of complications, the type and the generation of the transcatheter heart valve, and the study periods.…”

“…42 Regarding bleeding complications, 38,39 a major study demonstrated a significantly lower incidence of major bleeding complications with a percutaneous approach at 30 days (RR: 0.43; 95%CI 0.20-0.93; p=0.03). 40 Additionally, percutaneous approach was associated with a shorter LOS compared with surgical cutdown approach in several studies, 36,37 and a meta-analysis including 9 studies and 4,280 patients. 43 However, LA/CS tends to be more often used in percutaneous approach, which may have affected the LOS.…”

Percutaneous access versus surgical cut down for TAVR: Where do we go from here?

“…In this edition of CCI, Drafts et al presents the short‐ and late‐term results of PC versus SC transferal (TF) approach in 146 patients in regards to clinical outcomes retrospectively based on VARC‐2 (Valve academic research consortium) . Majority of the patients were male and Caucasians and mostly Corevalve platform was used.…”