Cut-down Access to Avoid Vascular Complications During Transcatheter Aortic Valve Implantation

Abstract

Objective: Vascular Complications (VCs) are independent predictors of mortality after Transcatheter Aortic Valve Implantation with Transfemoral Access (TF-TAVI) and remain an unsolved problem regardless of the Percutaneous (PC) or Surgical Cut-down (SC) access for patients with severe Aortic Valve Stenosis (AVS). The debate about the short- and long-term results, safety, risks of procedural complications and the complementary roles of SC and PC approaches is still open. We aim to show VCs in our series of patients submitted to TF-TAVI using a surgical-cutdown. Methodsː Retrospective analysis of consecutive patients with symptomatic severe AVS receiving TF-TAVI. The accesses were studied by computed tomography and Echo Color Doppler. The STS score was <4 in 172 (66.4%), 4-8 in 72 (27.8%) and >8 in 15 (5.8%) patients. The outcomes were the incidence of VCs. SC procedures were applied by Edwards SAPIENTM 3 (Edwards Lifesciences, Irvine, CA, USA) BE device. Resultsː We enrolled 259 patients, 244 (94.2%) underwent TF-TAVI with the SC approach. The mean patients’ age was 82 ± 2 (range: 58-99). Female patients were 160/259 (62%) and male 99/259 (38%). The mean fluoroscopic time was 22 minutes. The 30-day mortality rate was 0.77% (two deaths). Intraoperative VCs were 6 (2.3%) and 1 (0.4%) at 1-year follow-up. The ICU stay was one day, the median post-operative hospitalization was two days. Conclusionː This study contributes to the debate about the advantages of the SC approach compared to PC according to the patients’ profile with AVS and proposes multicenter prospective trials, especially for a future TAVI use in young and low-risk patients.