ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2020 February;61(1):117-22

DOI: 10.23736/S0021-9509.19.11087-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Vascular access site complications after transfemoral transcatheter aortic valve implantation in the POL-TAVI Registry: surgical versus percutaneous approach

Ryszard L. WALAS ¹, Leszek KUKULSKI ¹ ✉, Jan RYCHTER ¹, Tomasz JAŹWIEC ¹, Mateusz GĄSKA ¹, Michał HAWRANEK ², Marian ZEMBALA ¹, Mariusz GĄSIOR ², Michał O. ZEMBALA ¹

¹ Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland; ² Tird Department of Cardiology, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland

BACKGROUND: Transfemoral transcatheter aortic valve implantation (TF TAVI) has recently become an established treatment option for intermediate and high-risk surgical patients with severe aortic stenosis. Despite significant reduction in diameter of valvular delivery systems, access related vascular complications remain a major safety concern. The aim of this study was to evaluate impact of femoral access techniques: surgical versus percutaneous on in-hospital outcomes.
METHODS: Polish National TAVI Registry (POL-TAVI) was used as a data source. The analysis included 1680 patients treated with TF TAVI in years 2013-2016. 677 patients were treated using percutaneous technique (Group PC) and 1003 using open surgical access (Group S). The two groups were matched and compared. All-cause mortality, length of hospital stay, procedure time and potential risk factors for vascular access site complications after TF TAVI were analyzed.
RESULTS: Vascular access site complications were reported in 162 (9.64%) of 1680 patients and were found significantly more often in PC group (13.15% vs. 7.28% P>0.001). There was a significant difference between groups regarding Body Mass Index, arterial hypertension, transient ischemic attack history and NYHA classification. The data analysis showed that increased probability of all vascular complications was associated with percutaneous access. In addition, left-side access and female sex were independent risk factors for all vascular complications.
CONCLUSIONS: Surgical cut-down in the groin with exposure of the artery and manual suture after the procedure seems to be a safer option for TF TAVI patients.

KEY WORDS: Aortic valve stenosis; Transcatheter aortic valve replacement; Adverse effects; Vascular surgical procedures; Endovascular procedures; Postoperative complications