title: Propensity-matched comparison of percutaneous and surgical cut-down approaches in transfemoral transcatheter aortic valve implantation using a balloon-expandable valve.
abstract: OBJECTIVE
  This study aimed to compare the clinical outcomes of patients undergoing transfemoral transcatheter aortic valve implantation (TAVI) via a percutaneous or surgical cut-down approach.
  
  
  RESULTS
  Between October 2013 and July 2015, 586 patients underwent transfemoral TAVI according to the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry (percutaneous approach, n=305; surgical cut-down approach, n=281). After propensity matching, 166 patients underwent transfemoral TAVI via each approach. Major vascular complications, as defined per the Valve Academic Research Consortium-2 criteria, were found less frequently in patients who underwent a percutaneous approach (15.1% vs. 27.1%, p<0.01), and femoral artery injuries requiring surgical repair were mostly the result of a closure device failure (seven cases, 4.2%). In these patients, major bleeding was less (7.2% vs. 16.9%, p=0.01) and blood transfusion less frequent (21.1% vs. 38.0%, p<0.01); therefore, cases of acute kidney injury (AKI) were rare (6.0% vs. 15.1%, p<0.01).
  
  
  CONCLUSIONS
  Transfemoral TAVI using the percutaneous approach proved safe and feasible and resulted in fewer major vascular complications, bleeding and AKI events compared to the surgical cut-down approach.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kawashima
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Ken
authors.initials: K
authors.lastname: Kozuma
authors.forename: Yugo
authors.initials: Y
authors.lastname: Nara
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Hioki
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kataoka
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.forename: Norio
authors.initials: N
authors.lastname: Tada
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.forename: Futoshi
authors.initials: F
authors.lastname: Yamanaka
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome