Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the <scp>B</scp>razilian <scp>TAVI</scp> registry

Bernardi, F; Gomes, Wilton Francisco; Brito, Fábio Sândoli de; Mangione, José Armando; Sarmento‐Leite, Rogério; Siqueira, Dimitry; Carvalho, Lucila; Tumelero, Rogério Tadeu; Guérios, Ênio Eduardo; Lemos, Pedro A.

doi:10.1002/ccd.25820

Cited by 27 publications

(25 citation statements)

References 14 publications

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“…22) This interpretation has been further supported by the results of the recently published registry, in which TAVI was performed from the TF access mainly with 18 French sheaths, and the outcomes were reported according to the VARC-2 criteria. 23) At 30 days the frequency of LT/D was similar to that in our study, reaching 8.3% and 6.6% in the surgical cutdown and complete percutaneous approach, respectively.…”

Section: Discussionsupporting

confidence: 88%

Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation

et al. 2016

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SummaryThere are differences in reporting bleeding complications after transcatheter aortic valve implantation (TAVI), which is a consequence of the lack of consensus for their definition. Furthermore, the amount of data on the impact of peri-procedural bleeding on the mid-term prognosis is still limited. The aim of this study was to investigate the incidence, predictors, and impact of life-threatening and major bleedings as defined by the Valve Academic Research Consortium 2 (VARC-2) in patients after TAVI over the mid-term prognosis.Consecutive patients who underwent TAVI from March 2010 to December 2013 were included. All data were classified according to the VARC-2 criteria. We assessed the incidence and the predictors of serious bleeding events (SBE), defined as life-threatening/disabling (LT/D) or major bleeding, and analyzed their impact on 30-day and 1-year clinical outcome.A total of 129 patients were included (79.1 ± 8.3 years; mean EuroSCORE = 17.8 ± 12.7). The SBE occurred in 25 patients (19.4%), of which 9 (7.0%) had LT/D and 16 (12.4%) had major bleeding. Trans-subclavian (TS) access (OR 4.38, 95% CI 2.13-14.29, P = 0.01) and diabetes (OR 2.93, 95% CI 1.08-7.93, P = 0.03) were identified as independent predictors of SBE. Patients with SBE had higher 30-day mortality (20.0% versus 4.0%, P = 0.02) and 1-year mortality (40.0% versus 11.1%, P < 0.002). SBE independently predicted 1-year, all-cause mortality (HR 5.88, 95% CI 1.73-19.94, P = 0.005).SBE are frequent after TAVI and are associated with decreased short and mid-term survival. Diabetes and TS access are independent risk factors for SBE. (Int Heart J 2016; 57: 35-40) Key words: Long term prognosis, TAVR, Complications O ver the last several years we have been witnessing a substantial technical improvement and dynamic expansion of transcatheter aortic valve implantation (TAVI). Increasing operator experience and encouraging clinical outcomes data, revealing favorable results for TAVI in selected populations, have led to major changes in the management of patients with severe aortic stenosis (AS). In recent guidelines, TAVI has been recognized as an alternative method to surgical aortic valve replacement (SAVR) in high-risk patients and superior over conservative therapy in those disqualified from surgery. 1,2) Nevertheless, this procedure carries a substantial risk of numerous cardiovascular complications, among which the bleeding events are reported as the most frequent.3-7) Still, the body of evidence regarding the frequency of bleeding complications is relatively small, with significant differences in incidence between the studies, which is probably the result of differences in the applied methodology. [8][9][10] The clinical and procedural predictors of bleeding complications are not yet fully identified, and neither is their prognostic value. 3,7,8,10) Although the impact of bleeding on short-term mortality has been demonstrated, the influence on mid-term outcomes remains unclear. 11)To address the issue of heterogeneous reporting of out...

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Section: Discussionsupporting

confidence: 88%

Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation

et al. 2016

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“…Most of the presently available data showed noninferiority of the percutaneous approach but at once failed to demonstrate the claimed reduced invasiveness with regard on the clinical outcome . On the contrary, the present series is in line with the study by Bruschi, both indicating superiority of the surgical cut‐down technique with regard of access and bleeding complications .…”

Section: Discussionsupporting

confidence: 83%

“…These contrary results underline the present ambiguity concerning the ideal approach. None of the available studies could demonstrate superiority of a complete percutaneous approach . Accordingly, advocating exceptional use of this alleged “less invasive” approach is not justified.…”

Section: Discussionmentioning

confidence: 99%

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Surgical cut‐down or percutaneous access—which is best for less vascular access complications in transfemoral TAVI?

Spitzer

Wilbring²,

Alexiou³

et al. 2015

Cathet Cardio Intervent

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“…Especially during the placement of VCDs into the femoral artery and closure, extra CM use is required. Many literature studies have examined CIN and renal failure development subsequent to TAVI (16,17,32) . However, a study that examines CIN development by vascular closure techniques is not available.…”

Section: Percutaneous Closure Device Failurementioning

confidence: 99%

Importance of Femoral Access Method in Predicting the Development of Contrast Induced Nephropathy after Transfemoral Transcatheter Aortic Valve Implantation

Gül¹,

Zungur²,

Taştan³

et al. 2016

Kosuyolu Heart Journal

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Introduction: Transcatheter aortic valve implantation (TAVI) is more reliable than surgical valve replacement for high-risk or inoperable aortic stenosis patients. In this study, we aimed to investigate the effects of different femoral access methods on the development of vascular complications and contrast-induced nephropathy (CIN) after transfemoral (TF)-TAVI. Patients and Methods:In total, 110 patients (aged 78.9 ± 12.2 years; 55 females) who underwent aortic valve replacement by TF-TAVI between June 2013 and April 2015 were included in the study. CIN was defi ned as an absolute increase in serum creatinine level of > 0.5 mg/dL or a relative increase of > 25% within 48-72 h after TF-TAVI. The patients were classifi ed into two groups according to the femoral access methods: surgical cut-down (SCD) and vascular closure device (VCD) groups. Results:The amount of contrast medium (CM; p< 0.001) and the incidence of CIN (p= 0.038) were higher in the VCD group. Baseline glomerular fi ltration rate (GFR), baseline creatinine, Mehran score and CM were determined as the predictive factors of CIN development. Receiver operating characteristic analysis revealed that CM, which may predict the development of CIN, was determined as 178.5 mL, and GFR, which may predict the development of CIN, was determined as 48.9 mL/dk/1.73 m 2 .Conclusion: It may be preferred to perform the femoral arterial procedure using the SCD method instead of VCD in TAVI patients whose GFR is < 48.9; the use of CM may increase due to various reasons.

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Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry

Abstract: Total percutaneous techniques or surgical cutdown and closure may provide similar safety and effectiveness during the first year of follow-up in patients undergoing transfemoral TAVI.

Cited by 27 publications

References 14 publications

Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation

Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation

Surgical cut‐down or percutaneous access—which is best for less vascular access complications in transfemoral TAVI?

Importance of Femoral Access Method in Predicting the Development of Contrast Induced Nephropathy after Transfemoral Transcatheter Aortic Valve Implantation

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