title: Complete percutaneous approach for arterial access in transfemoral transcatheter aortic valve replacement: a comparison with surgical cut-down and closure.
abstract: OBJECTIVE
  This study sought to investigate the immediate safety and feasibility of complete percutaneous access/closure of arteriotomy for device deployment compared to the surgical approach for transfemoral transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  The percutaneous approach for arterial access for device deployment in transfemoral TAVR is a potential alternative to the surgical approach.
  
  
  METHODS
  In 274 patients who underwent transfemoral TAVR using Edward Sapien heart valve, 140 had a complete percutaneous approach using a "pre-closure" technique whereas 134 had surgical cut-down/repair for arterial access/closure of device deployment. Immediate vascular access/closure success, associated complications and clinical outcomes were compared.
  
  
  RESULTS
  While overall acute success of access/closure and in-hospital access-related events were similar, significant isolated stenosis/dissection at the access site developed more frequently in the percutaneous group (7.1% vs. 0.7%, P = 0.007). Contrary, wound infections requiring prolonged antibiotics use or surgical debridement occurred more frequently in the surgical group (0.7% vs. 6.7%, P = 0.007). Although the rate of major vascular complications was not different, the surgical group developed more frequent minor bleeding (27.1% vs. 38.8%, P = 0.04) and underwent transfusion of packed red blood cells of ≤3 units (25.7% vs. 43.3%, P = 0.002). Median hospital stay was shorter in the percutaneous group (3 days vs. 4 days, P = 0.002).
  
  
  CONCLUSIONS
  The percutaneous approach is a feasible access/closure method with a potential of lowering access site infection and bleeding, and shortening hospital stay, while maintaining similar rates of major vascular complications compared to the surgical approach.
authors.affiliation: Cardiovascular Intervention Center and Cardiothoracic Surgery, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Niraj
authors.initials: N
authors.lastname: Doctor
authors.forename: Suhail
authors.initials: S
authors.lastname: Dohad
authors.forename: Gregory
authors.initials: G
authors.lastname: Fontana
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003646:Debridement; D017707:Erythrocyte Transfusion; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006489:Hemostatic Techniques; D006801:Humans; D007902:Length of Stay; D008297:Male; D011474:Prosthesis Design; D011677:Punctures; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: TAVR; pre-closure; vascular complications