Percutaneous access versus surgical cutdown in TAVI: vascular and bleeding complications. (14th October 2021)

• Record Type: Journal Article
• Authors: Stathogiannis, K; Latsios, G; Oikonomou, G; Synetos, A; Drakopoulou, M; Soulaidopoulos, S; Toskas, P; Xanthopoulou, M; Lalou, E; Kolyviras, A; Tzifos, V; Benetos, G; Karmpalioti, M; Tsioufis, C; Toutouzas, K
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Valves; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.2253
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Access options for transcatheter aortic valve implantation (TAVI) are vital, since use of large sheaths may lead to access-related complications and bleeding. Purpose: To determine the access-related vascular and bleeding complications of patients undergoing transfemoral TAVI. Methods: Consecutive patients scheduled for transfemoral TAVI were retrospectively grouped according to vascular access [percutaneous access (p-TAVI) and surgical cutdown (sc-TAVI)]. Primary end points were vascular and bleeding complications, based on the VARC-II criteria. 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<0.001). 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<0.001), which resulted in higher rates of acute kidney injury in the sc-TAVI group (13% versus 1%, p=0.01). 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=0.10). 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=0.49), but no life-threatening bleeding (0% versus 1.5%). Conclusions: Transfemoral access options in TAVI (surgical cutdown or percutaneous) have similar efficacy and should be offered in TAVI patients if and when appropriate. FUNDunding Acknowledgement: Type of funding sources: None.