title: Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry.
abstract: OBJECTIVE
  To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approach for transfemoral transcatheter aortic valve implantation (TAVI), among "real-world" patients from the multi-center Brazilian TAVI registry.
  
  
  BACKGROUND
  Vascular access still remains a major challenge for TAVI via transfemoral approach. Vascular access through complete percutaneous approaches or through open surgical vascular techniques seems to be acutely similar. However, the long-term outcomes of both techniques remain poorly described.
  
  
  METHODS
  The study population comprised all patients treated via transfemoral route in the Brazilian TAVI registry, a "real-world", nation-based, multi-center study. Patients were divided according to the initial vascular access approach (percutaneous vs. surgical) and clinically followed-up for 1 year. The primary endpoint was the incidence of combined adverse events all-cause mortality, life-threatening bleeding, and/or major vascular complication at 1 year.
  
  
  RESULTS
  A total of 402 patients from 18 centers comprised the study population (percutaneous approach in 182 patients; surgical cutdown approach 220 patients). The incidence of combined adverse events was not different in the percutaneous and the surgical groups at 30 days (17.6% vs. 16.3%; P = 0.8) and at 1 year (primary endpoint) (30.9% vs. 28.8%; P = 0.8). Also, the study groups overall were comparable regarding the incidence of each individual safety adverse events at 30 days and at 1 year.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Fernando L M
authors.initials: FL
authors.lastname: Bernardi
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Wilton F
authors.initials: WF
authors.lastname: Gomes
authors.affiliation: Department of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
authors.forename: Fabio S
authors.initials: FS
authors.lastname: de Brito
authors.affiliation: Department of Hemodynamic and Interventional Cardiology, Hospital Beneficencia Portuguesa, Sao Paulo, Brazil.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Mangione
authors.affiliation: Department of Hemodynamic and Interventional Cardiology, Heart Institute of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Rogério
authors.initials: R
authors.lastname: Sarmento-Leite
authors.affiliation: Heart Structural Diseases Interventions Center, Institute Dante Pazzanesede of Cardiology, Sao Paulo, Brazil.
authors.forename: Dimitry
authors.initials: D
authors.lastname: Siqueira
authors.affiliation: Department of Interventional Cardiology, Hospital Pro-Cardiaco, Rio De Janeiro, Brazil.
authors.forename: Luiz A
authors.initials: LA
authors.lastname: Carvalho
authors.affiliation: Department of Interventional Cardiology, Hospital São Vicente de Paulo, Passo Fundo, Brazil.
authors.forename: Rogério
authors.initials: R
authors.lastname: Tumelero
authors.affiliation: Department of Interventional Cardiology, Hospital Pilar, Curitiba, Brazil.
authors.forename: Enio E
authors.initials: EE
authors.lastname: Guerios
authors.affiliation: Department of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D001938:Brazil; D015897:Comorbidity; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D012042:Registries; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: aortic stenosis; transcatheter aortic valve implantation; vascular access