title: Surgical cut-down or percutaneous access-which is best for less vascular access complications in transfemoral TAVI?
abstract: OBJECTIVE
  Objective of the present study was to compare VARC-2 access and bleeding complications of a complete percutaneous versus a surgical cut-down approach for transfemoral TAVI "in a real world-all comers" setting.
  
  
  BACKGROUND
  The ideal approach for transfemoral TAVI is still part of a lively debate. Until today, for none of the available techniques superiority could be demonstrated. The present study adds a considerable number of patients to the available experience.
  
  
  METHODS
  The study included 334 consecutive patients, including 199 patients in the percutaneous and 135 patients in the cut-down group. Mean patient's age was 81.4 ± 4.6. Calculated logistic EuroSCORE correlated an intermediate to high surgical risk (17.8% ± 12.3%). Primary study endpoints were vascular access site as well as bleeding complications according the actual VARC-2 criteria.
  
  
  RESULTS
  Mean procedure time was significantly shorter in the cut-down group (69 ± 19 min vs. 91 ± 22 min; P < 0.01). Overall rate of VARC-2 access complications were significantly more frequent in the percutaneous group (n = 41/199; 20.6% vs. n = 11/135; 8.1%; P = 0.04); the incidence of major complications did not differ significantly (P = 0.19). VARC-2 bleeding complications were more frequent in the percutaneous group as well (18.1% vs. 4.4%; P = 0.029). Hospital stay differed not significantly (P = 0.214). Hospital mortality was 3.5% in the percutaneous group and 1.5% in the cut-down group (P = n.s.).
  
  
  CONCLUSIONS
  Surgical cut-down provided a convenient and controlled access, resulting in less access and bleeding complications. Nontheless, major access complication differed not significantly. Both approaches must be seen as complementary techniques. A portfolio containing both techniques is the exclusive way to provide a tailor-made and patient-orientated approach. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Praxisklinik Herz und Gefäße, Dresden, und Brandenburgische Technische Universität (BTU), Cottbus-Senftenberg, Germany.
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Spitzer
authors.affiliation: Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Wilbring
authors.affiliation: Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Alexiou
authors.affiliation: Praxisklinik Herz und Gefäße, Dresden, und Brandenburgische Technische Universität (BTU), Cottbus-Senftenberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Stumpf
authors.affiliation: Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
authors.forename: Utz
authors.initials: U
authors.lastname: Kappert
authors.affiliation: Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Matschke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011677:Punctures; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
keywords: TAVI; access complications; cut-down; percutaneous; transfemoral