Propensity-matched comparison of percutaneous and surgical cut-down approaches in transfemoral transcatheter aortic valve implantation using a balloon-expandable valve

Hideyuki Kawashima, Yusuke Watanabe, Ken Kozuma, Yugo Nara, Hirofumi Hioki, Akihisa Kataoka, Masanori Yamamoto, Kensuke Takagi, Motoharu Araki, Norio Tada, Shinichi Shirai, Futoshi Yamanaka, Kentaro Hayashida

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Aims: 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. Methods and 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.

Original languageEnglish
Pages (from-to)1954-1961
Number of pages8
JournalEuroIntervention
Volume12
Issue number16
DOIs
Publication statusPublished - 2017 Mar 1

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Acute Kidney Injury
Blood Vessels
Equipment Failure
Hemorrhage
Intraoperative Complications
Femoral Artery
Blood Transfusion
Registries
Catheters
Transcatheter Aortic Valve Replacement
Research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Propensity-matched comparison of percutaneous and surgical cut-down approaches in transfemoral transcatheter aortic valve implantation using a balloon-expandable valve. / Kawashima, Hideyuki; Watanabe, Yusuke; Kozuma, Ken; Nara, Yugo; Hioki, Hirofumi; Kataoka, Akihisa; Yamamoto, Masanori; Takagi, Kensuke; Araki, Motoharu; Tada, Norio; Shirai, Shinichi; Yamanaka, Futoshi; Hayashida, Kentaro.

In: EuroIntervention, Vol. 12, No. 16, 01.03.2017, p. 1954-1961.

Research output: Contribution to journalArticle

Kawashima, H, Watanabe, Y, Kozuma, K, Nara, Y, Hioki, H, Kataoka, A, Yamamoto, M, Takagi, K, Araki, M, Tada, N, Shirai, S, Yamanaka, F & Hayashida, K 2017, 'Propensity-matched comparison of percutaneous and surgical cut-down approaches in transfemoral transcatheter aortic valve implantation using a balloon-expandable valve', EuroIntervention, vol. 12, no. 16, pp. 1954-1961. https://doi.org/10.4244/EIJ-D-16-00408
Kawashima, Hideyuki ; Watanabe, Yusuke ; Kozuma, Ken ; Nara, Yugo ; Hioki, Hirofumi ; Kataoka, Akihisa ; Yamamoto, Masanori ; Takagi, Kensuke ; Araki, Motoharu ; Tada, Norio ; Shirai, Shinichi ; Yamanaka, Futoshi ; Hayashida, Kentaro. / Propensity-matched comparison of percutaneous and surgical cut-down approaches in transfemoral transcatheter aortic valve implantation using a balloon-expandable valve. In: EuroIntervention. 2017 ; Vol. 12, No. 16. pp. 1954-1961.
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AU - Kozuma, Ken

AU - Nara, Yugo

AU - Hioki, Hirofumi

AU - Kataoka, Akihisa

AU - Yamamoto, Masanori

AU - Takagi, Kensuke

AU - Araki, Motoharu

AU - Tada, Norio

AU - Shirai, Shinichi

AU - Yamanaka, Futoshi

AU - Hayashida, Kentaro

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AB - Aims: 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. Methods and 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.

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