title: Factors associated with vascular complications in patients undergoing balloon-expandable transfemoral transcatheter aortic valve replacement via open versus percutaneous approaches.
abstract: BACKGROUND
  Vascular complications after transfemoral transcatheter aortic valve replacement are common and associated with significant morbidity and mortality. Little is known about the effect of access approach on vascular complications.
  
  
  RESULTS
  Between 2007 and 2013, 331 patients underwent transfemoral transcatheter aortic valve replacement via open surgical (OS) or fully percutaneous (PC) approaches. Patient data and clinical outcomes were collected. Valve Academic Research Consortium-defined vascular complications were noted. Multivariable analysis with propensity matching was performed, and vascular complications, mortality, and length of stay were assessed. One hundred twenty patients were treated with the OS approach and 211 patients via the PC approach. There were fewer major vascular complications (11% versus 20%; P=0.03) and shorter length of stay (7.5 versus 9.9 days; P=0.003) in the PC group when compared with those in the OS group. In multivariable analysis, vascular complications were more likely in women (odds ratio, 2.2; P=0.02) and with increasing differences between sheath outer diameter and minimal artery diameter (overall vascular complications: odds ratio, 1.4; P=0.02 and major vascular complications: odds ratio, 2.0; P<0.001). Propensity-matched analysis demonstrated no difference in vascular complications between the OS and the PC groups (22% versus 19%; P=0.73) but significantly reduced length of stay in the PC group (7.9 versus 10.0 days; P=0.04).
  
  
  CONCLUSIONS
  Transfemoral transcatheter aortic valve replacement performed via the PC route is associated with similar risk of vascular complications and significantly lower postprocedural length of stay than the OS route. The degree of sheath oversizing with respect to iliofemoral minimal artery diameter and female sex are associated with vascular complications regardless of access approach.
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Mitul B
authors.initials: MB
authors.lastname: Kadakia
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Fox
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ogbara
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Saif
authors.initials: S
authors.lastname: Anwaruddin
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Jagasia
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vallabhajosyula
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Robert
authors.initials: R
authors.lastname: Li
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Rohan
authors.initials: R
authors.lastname: Menon
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Kobrin
authors.affiliation: From the Divisions of Cardiovascular Medicine (M.B.K., H.C.H., J.O., S.A., D.J., R.L., J.G.) and Cardiovascular Surgery (N.D.D., Z.F., J.E.B., W.Y.S., P.V., R.M., D.M.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia. giri.jay@gmail.com.
authors.forename: Jay
authors.initials: J
authors.lastname: Giri
mesh_terms: D000279:Administration, Cutaneous; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D012306:Risk; D012737:Sex Factors; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: aortic valve; aortic valve stenosis; peripheral vascular disease; vascular injuries