title: Surgical Versus Percutaneous Femoral Access for Delivery of Large-Bore Cardiovascular Devices (from the PARTNER Trial).
abstract: It is unclear if surgical exposure confers a risk advantage compared with a percutaneous approach for patients undergoing endovascular procedures requiring large-bore femoral artery access. From the randomized controlled Placement of Aortic Transcatheter Valve trials A and B and the continued access registries, a total of 1,416 patients received transfemoral transcatheter aortic valve replacement, of which 857 underwent surgical, and 559 underwent percutaneous access. Thirty-day rates of major vascular complications and quality of life scores were assessed. Propensity matching was used to adjust for unmeasured confounders. Overall, there were 116 major vascular complications (8.2%). Complication rates decreased dramatically during the study period. In unadjusted analysis, major vascular complications were significantly less common in the percutaneous access group (35 [6.3%] vs 81 [9.5%] p = 0.032). However, among 292 propensity-matched pairs, there was no difference in major vascular complications (22 [7.5%] vs 28 [9.6%], p = 0.37). Percutaneous access was associated with fewer total in-hospital vascular complications (46 [16%] vs 66 [23%], p = 0.036), shorter median procedural duration (97 interquartile range [IQR 68 to 166] vs 121 [IQR 78 to 194] minutes, p <0.0001), and median length of stay (4 [IQR 2 to 8] vs 6 [IQR 3 to 10] days, p <0.0001). There were no significant differences in quality of life scores at 30 days. Surgical access for large-bore femoral access does not appear to confer any advantages over percutaneous access and may be associated with more minor vascular complications.
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Washington. Electronic address: jmmccabe@uw.edu.
authors.forename: James M
authors.initials: JM
authors.lastname: McCabe
authors.affiliation: Sutter Heart & Vascular Institute, Sacramento, California.
authors.forename: Pei-Hsiu
authors.initials: PH
authors.lastname: Huang
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Division of Epidemiology and Statistics, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Division of Cardiology, University of Utah, Salt Lake City, Utah.
authors.forename: Frederick G P
authors.initials: FGP
authors.lastname: Welt
authors.affiliation: Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Davidson
authors.affiliation: Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Division of Cardiology, University of Texas, San Antonio, Texas.
authors.forename: Marvin H
authors.initials: MH
authors.lastname: Eng
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Keith B
authors.initials: KB
authors.lastname: Allen
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: Division of Epidemiology and Statistics, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Lowry
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Yang
authors.initials: Y
authors.lastname: Lei
authors.affiliation: Division of Epidemiology and Statistics, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.affiliation: Inverventional Cardiology, Baylor Scott and White Health, Plano, Texas.
authors.forename: David L
authors.initials: DL
authors.lastname: Brown
authors.affiliation: Cardiothoracic Surgery, Baylor Scott and White Health, Plano, Texas.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: Department of Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Department of Cardiology, Central Maine Heart and Vascular Institute, Lewiston, Maine; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Eisenhauer
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D005263:Femoral Artery; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology