Thorac Cardiovasc Surg
DOI: 10.1055/s-0041-1725202
Original Cardiovascular

Surgical Cutdown Avoids Vascular Complications in Transcatheter Aortic Valve Replacement in Calcified and Small Femoral Arteries

1  Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany
,
Hendrik Ruge#
1  Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany
,
1  Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany
,
Rüdiger Lange
1  Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany
2  Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich at the Technical University of Munich, Munich, Germany
3  DZHK (German Center for Cardiovascular Research)-partner Site Munich Heart Alliance, Munich, Germany
› Author Affiliations

Abstract

Background Third-generation transcatheter heart valves (THV) are predominantly implanted through a percutaneous, transfemoral access. To reduce vascular complications, we selectively performed surgical vascular access (cutdown) in patients with particular calcified or small femoral arteries. We aim to review our experience with this approach.

Methods All patients who underwent transfemoral transcatheter aortic valve replacement (TAVR) with a third-generation THV at our institution between March 2014 and April 2019 were included in the study. All available computerized tomography studies were reassessed for access vessel diameter and visual graduation of calcifications. Vascular complications are reported according to Valve Academic Research Consortium-2 criteria.

Results A total of 944 patients were included. Among them, 879 patients underwent a percutaneous access and 65 patients underwent surgical cutdown. Also, 459 Evolut R/PRO and 420 Sapien 3/ultra were implanted percutaneously and 40 Evolut R/PRO and 25 Sapien 3 were implanted with a surgical cutdown. Patients with surgical cutdown were older (80.0 ± 7.5 vs. 83.8 ± 7.5 years, p < 0.001), had smaller femoral arteries (8.0 ± 1.6 vs. 7.6 ± 1.6 mm, p = 0.034) and more severe vessel calcifications (17.5 vs. 1.0%, p < 0.001). Procedure time was similar for cutdown and percutaneous access (64.0 vs. 64.5 minutes, p = 0.879). With percutaneous access, 80 major vascular complications (10%) occurred, whereas with surgical cutdown, no major vascular complications occurred (p < 0.005). No wound infection occurred after surgical cutdown. The mean length of stay was 8 days in both groups.

Conclusion Surgical cutdown for vascular access avoids vascular complications in patients with small or severely calcified femoral arteries.

Sources of Funding

None.


# Both authors contributed equally.


Supplementary Material



Publication History

Received: 27 September 2020

Accepted: 14 January 2021

Publication Date:
24 March 2021 (online)

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