Totally Percutaneous Access Versus Surgical Cutdown In TAVI: A Two-Center Analysis According to the VARC-2 Vascular Complications Criteria
George Latsios, MD; Konstantinos Stathogiannis, MD; Vaios Tzifos, MD*; Andreas Synetos, MD;
Maria Drakopoulou, MD; Antonios Karanasos, MD; Athanasios Kolyviras*, MD; Leonidas Koliostasis, MD;
Pantelis Toskas, MD; Kostas Tsioufis, MD; Kostas Toutouzas, MD
From the 1st Department of Cardiology, Medical School of Athens University, Hippokration Hospital, Athens, Greece; and *Henry Dunant Hospital, Athens, Greece
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.
Manuscript accepted November 18, 2022.
Address for correspondence: Dr George Latsios, Vas. Sofias 114, 11527, Athens, Greece. Email: glatsios@gmail.com
Abstract
Background.
Vascular access in patients with aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI) is important. Vascular complications arising during the procedure confer a significant risk in the short- and long-term.
Methods.
Consecutive patients scheduled for transfemoral TAVI were retrospectively grouped according to vascular access [percutaneous access (p-TAVI) and surgical cutdown (sc-TAVI)]. Primary endpoints were vascular and bleeding complications and 30-day mortality.
Results.
Totally, 187 patients were included in the analysis (p-TAVI: 124 patients; sc-TAVI: 63 patients). Mean procedure time was shorter in the p-TAVI group compared to the sc-TAVI group (45.65±6.17 min versus 64.05±15.73 min, P<.001). Contrast use was lower in the p-TAVI group compared to the sc-TAVI group (81.18±15.96 ml versus 106.75±25.67 ml, P<.001), which resulted in higher rates of acute kidney injury in the sc-TAVI group (13% versus 1%, P=.01). Vascular access complications occurred numerically but not statistically more often in the p-TAVI group compared to the sc-TAVI group (11% versus 5% for minor complications and 6% versus 3% for major complications respectively, P=.10). Patients in the p-TAVI group had the same minor and major bleeding complications compared to the sc-TAVI group (11% versus 8% for minor, 10% versus 6% for major bleeding complications respectively, P=.49), but no life-threatening bleeding (0% versus 1.5%). Stroke rate and 30-day all-cause mortality was similar for both groups.
Conclusion.
Surgical cutdown offers a non-statistically significant advantage in terms of vascular complications but not overall bleeding, in the cost of longer and more contrast demanding procedures.
J CRIT LIMB ISCHEM 2022;2(x):Exc=Exv