Marco Gennari1, Marta Rigoni2,3, Giorgio Mastroiacovo1, Piero Trabattoni1, Maurizio Roberto1, Antonio L Bartorelli4, Franco Fabbiocchi5, Gloria Tamborini6, Manuela Muratori6, Laura Fusini6, Mauro Pepi7, Paola Muti3,8, Gianluca Polvani8,9, Marco Agrifoglio1,8. 1. Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy. 2. Department of Industrial Engineering, University of Trento, 38100 Trento, Italy. 3. Department of Oncology and Health, Evidence, and Impact, McMaster University, Hamilton, L0P ON, Canada. 4. Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, 20100 Milan, Italy. 5. Department of Invasive Cardiology, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy. 6. Department of Cardiovascular Imaging, IRCCS Centro CArdiologico Monzino, 20100 Milan, Italy. 7. Clinical Area Director, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy. 8. Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy. 9. Chief of Cardiovascular Surgery Department, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy.
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosis patients with a wide range of surgical risk. Currently, the common femoral artery is the first choice as the main access route for the procedure. The objective of this observational study is to report our experience on percutaneous and surgical cut-down transfemoral TAVRs comparing the two approaches. METHODS: From January 2014 to January 2019, five hundred eleven consecutive patients underwent TAVR for severe symptomatic aortic stenosis. We analyzed only elective transfemoral procedures. After propensity score-matching based on age, sex, EuroSCORE II, mean aortic gradient, and left ventricular ejection fraction, we obtained two homogeneous populations: surgical cut-down (n = 119) and percutaneous (n = 225), which were labeled Group 1 and Group 2, respectively. RESULTS: The main findings were that there were no significant procedural outcome differences between the two groups, but Group 2 patients had a shorter length of hospital stay and were more frequently discharged home. At follow-up, Group 1 patients had lower survival rates. CONCLUSIONS: An accurate preoperative assessment of the femoral access is mandatory to achieve satisfactory outcomes with transfemoral TAVRs. Nevertheless, the percutaneous approach allows shorter in-hospital stay and the need for rehabilitation, thus potentially decreasing the costs of the procedure.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosispatients with a wide range of surgical risk. Currently, the common femoral artery is the first choice as the main access route for the procedure. The objective of this observational study is to report our experience on percutaneous and surgical cut-down transfemoral TAVRs comparing the two approaches. METHODS: From January 2014 to January 2019, five hundred eleven consecutive patients underwent TAVR for severe symptomatic aortic stenosis. We analyzed only elective transfemoral procedures. After propensity score-matching based on age, sex, EuroSCORE II, mean aortic gradient, and left ventricular ejection fraction, we obtained two homogeneous populations: surgical cut-down (n = 119) and percutaneous (n = 225), which were labeled Group 1 and Group 2, respectively. RESULTS: The main findings were that there were no significant procedural outcome differences between the two groups, but Group 2 patients had a shorter length of hospital stay and were more frequently discharged home. At follow-up, Group 1 patients had lower survival rates. CONCLUSIONS: An accurate preoperative assessment of the femoral access is mandatory to achieve satisfactory outcomes with transfemoral TAVRs. Nevertheless, the percutaneous approach allows shorter in-hospital stay and the need for rehabilitation, thus potentially decreasing the costs of the procedure.