Cut-Down Outperforms Complete Percutaneous Transcatheter Valve Implantation

Markus Mach ¹, Manuel Wilbring ², Konstantin Alexiou ², Utz Kappert ², Martin Grabenwöger ¹, Klaus Matschke ²

¹ Hospital Hietzing, Department of Cardiovascular Surgery, Vienna, Austria; ² University Heart Center Dresden, Dresden, Germany;

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

Background: The ideal approach for transfemoral transcatheter aortic valve implantation (TAVI) is still widely debated. Objective of the present study was to compareaccess and bleeding complications of complete percutaneous versus surgical cut-down approach for transfemoral TAVI in a real-world all-comers setting.

Methods: The study included 667 consecutive patients from November 2008 to December 2016, 466 patients in the percutaneous and 201 patients in the cut-down group. Mean patient’s age was 81.5±5.2 years [percutaneous] vs. 80.5±4.7 years [cut-down] (p=0.351). Calculated logistic EuroSCORE correlated an increased surgical risk (19.3±13.3 vs. 17.8±7.4%, p=0.488). Primary study endpoints were vascular access site as well as bleeding complications according to the VARC-2 criteria.

Results:There were no significant differences regarding baseline characteristics between both groups. Mean procedure time was significantly shorter in the cut-down group (93.5±22.0min [percutaneous]vs.69±19 min [cut-down];p<0.001). Overall rate of VARC-2 access complications were more frequent in the percutaneous group (20.4% [95/466]vs.8.5%[17/201];p=0.037); with predominantly minor complications in the percutaneous cohort (14.4%[67/466]vs.2.5%[5/201];p=0.04). Overall bleeding complications were more frequent in the percutaneous group (21.9%[102/466] vs. 4.5%[9/201];p=0.01). Hospital mortality was 5.2% in the percutaneous group and 1.9% in the cut-down group (p=0.075).

Conclusions: Surgical cut-down provided controlled access resulting in less access site and bleeding complications. Nonetheless, major access complications were not significantly different between the two cohorts. Both approaches must be seen as complementary techniques. A portfolio containing both techniques is the exclusive way to provide a tailor-made and patient-orientated approach warranting the safest access based on the individual vessel condition.