Puncture Versus Surgical Cutdown Complications of Transfemoral Aortic Valve Implantation (from the Spanish TAVI Registry)

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• 作者：Marco Herná ; ndez-Enriquez ; MD^a ; Rut Andrea ; MD ; PhD^a ; Salvatore Brugaletta ; MD ; PhD^a ; Pilar Jimé ; nez-Quevedo ; MD ; PhD^b ; José ; Marí ; a Herná ; ndez-Garcí ; a ; MD^c ; Ramiro Trillo ; MD^d ; Mariano Larman ; MD^e ; Francisco Ferná ; ndez-Avilé ; s ; MD^f ; Nicolá ; s Vá ; zquez-Gonzá ; lez ; MD^g ; André ; s I&ntilde ; iguez ; MD^h ; Javier Zueco ; MDⁱ ; Rafael Ruiz-Salmeró ; n ; MD^j ; Raquel del Valle ; MD^k ; Eduardo Molina ; MD^l ; Bruno Garcí ; a del Blanco ; MD^m ; Alberto Berenguer ; MDⁿ ; Mariano Valdé ; s ; MD^o ; Raú ; l Moreno ; MD^p ; Cristó ; bal Urbano-Carrillo ; MD^q ; Rosana Herná ; ndez-Antolí ; n ; MD^r ; Federico Gimeno ; MD^s ; Á ; ngel Cequier ; MD^t ; Ignacio Cruz ; MD^u ; José ; Ramó ; n Ló ; pez-Mí ; nguez ; MD^v ; José ; Ignacio Aramendi ; MD^w ; Á ; ngel Sá ; nchez ; MD^x ; Javier Goicolea ; MD^y ; Agustí ; n Albarrá ; n ; MD^z ; José ; Francisco Dí ; az ; MD^aa ; Felipe Navarro ; MD^bb ; José ; Moreu ; MD^cc ; André ; s Morist ; MD^dd ; Eduard Ferná ; ndez-Nofrerí ; as ; MD^ee ; Felipe Ferná ; ndez-Vá ; zquez ; MD^ff ; Francisco Ten ; MD^gg ; Vicente Mainar ; MD^hh ; Belé ; n Mari ; MDⁱⁱ ; Alberto Saenz ; MD^jj ; Fernando Alfonso ; MD^kk ; José ; Antonio Diarte ; MD^ll ; Manuel Sancho ; MD^mm ; Romá ; n Lezá ; un ; MDⁿⁿ ; Dabit Arzamendi ; MD^oo ; Manel Sabaté ; MD ; PhD^a ; ^{manelsabate1@telefonica.net" class="auth_mail" title="E-mail the corresponding author}
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：15 August 2016
• 年：2016
• 卷：118
• 期：4
• 页码：578-584
• 全文大小：380 K

文摘

Vascular complications in transcatheter aortic valve implantation using transfemoral approach are related to higher mortality. Complete percutaneous approach is currently the preferred technique for vascular access. However, some centers still perform surgical cutdown. Our purpose was to determine complications related to vascular access technique in the population of the Spanish TAVI National Registry. From January 2010 to July 2015, 3,046 patients were included in this Registry. Of them, 2,465 underwent transfemoral approach and were treated with either surgical cutdown and closure (cutdown group, n = 632) or percutaneous approach (puncture group, n = 1,833). Valve Academic Research Consortium-2 definitions were used to assess vascular and bleeding complications. Propensity matching resulted in 615 matched pairs. Overall, 30-day vascular complications were significantly higher in the puncture group (109 [18%] vs 42 [6.9%]; relative risk [RR] 2.60; 95% confidence interval [CI] 1.85 to 3.64, p <0.001) due mostly by minor vascular events (89 [15%] vs 25 [4.1%], RR 3.56, 95% CI 2.32 to 5.47, p <0.001). Bleeding rates were lower in the puncture group (18 [3%] vs 40 [6.6%], RR 0.45, 95% CI 0.26 to 0.78, p = 0.003) mainly driven by major bleeding (9 [1.5%] vs 21 [3.4%], RR 0.43, 95% CI 0.20 to 0.93, p = 0.03). At a mean follow-up of 323 days, complication rates remained significantly different between groups (minor vascular complications 90 [15%] vs 31 [5.1%], hazard ratio 2.99, 95% CI 1.99 to 4.50, p <0.001 and major bleeding 10 [1.6%] vs 21 [3.4%], hazard ratio 0.47, 95% CI 0.22 to 1.0, p = 0.04, puncture versus cutdown group, respectively). In conclusion, percutaneous approach yielded higher rates of minor vascular complications but lower rates of major bleeding compared with the surgical cutdown, both at 30-day and at mid-term follow-up in our population.