title: Puncture Versus Surgical Cutdown Complications of Transfemoral Aortic Valve Implantation (from the Spanish TAVI Registry).
abstract: Vascular complications in transcatheter aortic valve implantation using transfemoral approach are related to higher mortality. Complete percutaneous approach is currently the preferred technique for vascular access. However, some centers still perform surgical cutdown. Our purpose was to determine complications related to vascular access technique in the population of the Spanish TAVI National Registry. From January 2010 to July 2015, 3,046 patients were included in this Registry. Of them, 2,465 underwent transfemoral approach and were treated with either surgical cutdown and closure (cutdown group, n = 632) or percutaneous approach (puncture group, n = 1,833). Valve Academic Research Consortium-2 definitions were used to assess vascular and bleeding complications. Propensity matching resulted in 615 matched pairs. Overall, 30-day vascular complications were significantly higher in the puncture group (109 [18%] vs 42 [6.9%]; relative risk [RR] 2.60; 95% confidence interval [CI] 1.85 to 3.64, p <0.001) due mostly by minor vascular events (89 [15%] vs 25 [4.1%], RR 3.56, 95% CI 2.32 to 5.47, p <0.001). Bleeding rates were lower in the puncture group (18 [3%] vs 40 [6.6%], RR 0.45, 95% CI 0.26 to 0.78, p = 0.003) mainly driven by major bleeding (9 [1.5%] vs 21 [3.4%], RR 0.43, 95% CI 0.20 to 0.93, p = 0.03). At a mean follow-up of 323 days, complication rates remained significantly different between groups (minor vascular complications 90 [15%] vs 31 [5.1%], hazard ratio 2.99, 95% CI 1.99 to 4.50, p <0.001 and major bleeding 10 [1.6%] vs 21 [3.4%], hazard ratio 0.47, 95% CI 0.22 to 1.0, p = 0.04, puncture versus cutdown group, respectively). In conclusion, percutaneous approach yielded higher rates of minor vascular complications but lower rates of major bleeding compared with the surgical cutdown, both at 30-day and at mid-term follow-up in our population.
authors.affiliation: Cardiology Department, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Marco
authors.initials: M
authors.lastname: Hernández-Enriquez
authors.affiliation: Cardiology Department, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Rut
authors.initials: R
authors.lastname: Andrea
authors.affiliation: Cardiology Department, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.affiliation: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Jiménez-Quevedo
authors.affiliation: Cardiology Department, Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Hernández-García
authors.affiliation: Cardiology Department, Complejo Hospitalario Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Trillo
authors.affiliation: Cardiology Department, Policlínica Guipuzcoa, San Sebastián, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Larman
authors.affiliation: Cardiology Department, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Cardiology Department, Complejo Hospitalario Universitario A Coruña, Coruña, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Vázquez-González
authors.affiliation: Cardiology Department, Complejo Hospitalario Universitario de Vigo (Meixoeiro), Vigo, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Iñiguez
authors.affiliation: Cardiology Department, Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Zueco
authors.affiliation: Cardiology Department, Hospital Virgen de la Macarena, Sevilla, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ruiz-Salmerón
authors.affiliation: Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Del Valle
authors.affiliation: Cardiology Department, Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Molina
authors.affiliation: Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: García Del Blanco
authors.affiliation: Cardiology Department, Hospital General de Valencia, Valencia, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Berenguer
authors.affiliation: Cardiology Department, Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.affiliation: Cardiology Department, Hospital La Paz, Madrid, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.affiliation: Cardiology Department, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Urbano-Carrillo
authors.affiliation: Cardiology Department, Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.affiliation: Cardiology Department, Hospital Clínico de Valladolid, Valladolid, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Gimeno
authors.affiliation: Cardiology Department, Hospital Universitario de Bellvitge, Barcelona, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Cequier
authors.affiliation: Cardiology Department, Complejo Hospitalario Salamanca, Salamanca, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cruz
authors.affiliation: Cardiology Department, Hospital Universitario Infanta Cristina, Badajoz, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: López-Mínguez
authors.affiliation: Cardiovascular Surgery Department, Hospital de Cruces, Bilbao, Spain.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Aramendi
authors.affiliation: Cardiology Department, Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Sánchez
authors.affiliation: Cardiology Department, Hospital Majadahonda-Puerta de Hierro, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Goicolea
authors.affiliation: Cardiology Department, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Albarrán
authors.affiliation: Cardiology Department, Hospital Juan Ramón Jiménez, Huelva, Spain.
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Díaz
authors.affiliation: Cardiology Department, Fundación Jiménez-Díaz, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Navarro
authors.affiliation: Cardiology Department, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Moreu
authors.affiliation: Cardiology Department, Hospital de Basurto, Bilbao, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Morist
authors.affiliation: Cardiology Department, Hospital Universitario Germans Trias i Pujol, Badalona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Fernández-Nofrerías
authors.affiliation: Cardiology Department, Hospital Universitario de León, León, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Fernández-Vázquez
authors.affiliation: Cardiology Department, Hospital La Fe, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ten
authors.affiliation: Cardiology Department, Hospital General de Alicante, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Mainar
authors.affiliation: Cardiology Department, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Mari
authors.affiliation: Cardiology Department, Clínica Los Manzanos, Logroño, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Saenz
authors.affiliation: Cardiology Department, Hospital La Princesa, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.affiliation: Cardiology Department, Hospital Miguel Servet, Zaragoza, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Diarte
authors.affiliation: Cardiology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Sancho
authors.affiliation: Cardiology Department, Hospital de Navarra, Pamplona, Spain.
authors.forename: Román
authors.initials: R
authors.lastname: Lezáun
authors.affiliation: Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Dabit
authors.initials: D
authors.lastname: Arzamendi
authors.affiliation: Cardiology Department, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. Electronic address: manelsabate1@telefonica.net.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D003287:Contrast Media; D004210:Dissection / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D005471:Fluoroscopy; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011677:Punctures / Q000379:methods*; D012042:Registries; D013030:Spain; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
chemical_list: D003287:Contrast Media