Comparison of surgical cutdown and percutaneous puncture in transcatheter aortic valve replacement_West China Medical Journal

Authors：

YU Yuanyuan ¹ , LI Yijian ² , WANG Yali ² , GUO Huili ² , XIONG Tianyuan ² , LIAO Yanbiao ² , WANG Xi ¹ , CHEN Fei ² , OU Yuanweixiang ² , LIU Qi ² , CHEN Mao ² ,  FENG Yuan ²

1. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FENG Yuan, Email: fynotebook@hotmail.com

Keywords：

Transcatheter aortic valve replacement; surgical cutdown; percutaneous puncture; complications

DOI：

10.7507/1002-0179.202203095

Video：

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Objective To compare the clinical and hemodynamic results of patients undergoing transcatheter aortic valve replacement (TAVR) with different vascular approaches. Methods We retrospectively analyzed the baseline status, procedure status, procedure-related clinical complications defined by Valve Academic Research Consortium-2 consensus document, and postoperative hemodynamic results of patients with severe aortic stenosis who underwent TAVR between April 2012 and January 2019 in West China Hospital of Sichuan University. Results A total of 436 patients were enrolled, including 58 patients undergoing surgical cutdown and 378 patients undergoing percutaneous puncture. The prevalence of tumor in the surgical cutdown group was higher than that in the percutaneous puncture group (8.62% vs. 2.65%, P=0.037), while the other baseline characteristics, including age, male proportion, body mass index, and Society of Thoracic Surgeons scores, were similar between the two groups (P>0.05); the proportion of patients with aortic regurgitation equal to or greater than a moderate degree in the surgical cutdown group was lower than that in the percutaneous puncture group (22.41% vs. 35.98%, P=0.043), and there was no statistically significant difference in other preoperative cardiac ultrasound-related indicators (P>0.05). The procedure success rate was high in both groups (96.55% vs. 98.68%, P=0.236). Immediately after operation, the incidences of new-onset left bundle branch block (43.10% vs. 24.87%, P=0.004), severe bleeding (12.07% vs. 4.23%, P=0.030), and mild bleeding (20.69% vs. 3.44%, P<0.001) were higher in the surgical cutdown group than those in the percutaneous puncture group, and the postoperative hemodynamics indicated that there was no statistically significant difference in maximum blood flow velocity between the two groups [(2.37±0.52) vs. (2.50±1.67) m/s, P=0.274]. At the 1 year follow-up, the cardiac death rate (5.17% vs. 3.17%, P=0.696) and all-causes mortality rate (8.62% vs. 8.47%, P=1.000) between the two groups were not statistically different.Conclusions Compared with percutaneous puncture, surgical cutdown is associated with a higher incidence of bleeding events, while the incidence of other clinical complications such as vascular complications and the postoperative hemodynamic outcomes were similar.

Citation： YU Yuanyuan, LI Yijian, WANG Yali, GUO Huili, XIONG Tianyuan, LIAO Yanbiao, WANG Xi, CHEN Fei, OU Yuanweixiang, LIU Qi, CHEN Mao, FENG Yuan. Comparison of surgical cutdown and percutaneous puncture in transcatheter aortic valve replacement. West China Medical Journal, 2022, 37(4): 522-530. doi: 10.7507/1002-0179.202203095 Copy

1.	Kanwar A, Thaden JJ, Nkomo VT. Management of patients with aortic valve stenosis. Mayo Clin Proc, 2018, 93(4): 488-508.
2.	Carabello B, Paulus WJ. Aortic stenosis. Lancet, 2009, 373(9667): 956-966.
3.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): 450-500.
4.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
5.	张怡, 熊恬园, 陈茂. 《2021 ESC/EACTS 心脏瓣膜病管理指南》解读:经导管瓣膜治疗策略的更新. 中国胸心血管外科临床杂志, 2021, 28(12): 1400-1408.
6.	Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement: part 1: basic anatomy, imaging, sheaths, wires, and access routes. JACC Cardiovasc Interv, 2013, 6(7): 643-653.
7.	Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement part 2: vascular complications. JACC Cardiovasc Interv, 2013, 6(8): 767-776.
8.	Walas RL, Kukulski L, Rychter J, et al. Vascular access site complications after transfemoral transcatheter aortic valve implantation in the POL-TAVI Registry: surgical versus percutaneous approach. J Cardiovasc Surg (Torino), 2020, 61(1): 117-122.
9.	Spitzer SG, Wilbring M, Alexiou KA, et al. Surgical cut-down or percutaneous access which is best for less vascular access complications in transfemoral TAVI?. Catheter Cardiovasc Interv, 2016, 88(2): E52-E58.
10.	Hernández-Enriquez M, Andrea R, Brugaletta S, et al. Puncture versus surgical cutdown complications of transfemoral aortic valve implantation (from the Spanish TAVI registry). Am J Cardiol, 2016, 118(4): 578-584.
11.	Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J, 2012, 33(19): 2403-2418.
12.	Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg, 2007, 133(5): 1226-1233.
13.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
14.	Ducrocq G, Francis F, Serfaty JM, et al. Vascular complications of transfemoral aortic valve implantation with the Edwards SAPIEN prosthesis: incidence and impact on outcome. EuroIntervention, 2010, 5(6): 666-672.
15.	Holmes DR Jr, Nishimura RA, Grover FL, et al. Annual outcomes with transcatheter valve therapy: from the STS/ACC TVT Registry. J Am Coll Cardiol, 2015, 66(25): 2813-2823.
16.	Maniotis C, Andreou C, Karalis I, et al. A systematic review on the safety of Prostar XL versus ProGlide after TAVR and EVAR. Cardiovasc Revasc Med, 2017, 18(2): 145-150.
17.	Giordano A, Corcione N, Ferraro P, et al. Comparison of ProGlide vs prostar in patients undergoing transcatheter aortic valve implantation. Minerva Cardioangiol, 2019, 67(6): 443-449.
18.	Xiong TY, Li YJ, Feng Y, et al. Understanding the interaction between transcatheter aortic valve prostheses and supra-annular structures from post-implant stent geometry. JACC Cardiovasc Interv, 2019, 12(12): 1164-1171.
19.	Manunga JM, Gloviczki P, Oderich GS, et al. Femoral artery calcification as a determinant of success for percutaneous access for endovascular abdominal aortic aneurysm repair. J Vasc Surg, 2013, 58(5): 1208-1212.
20.	Hayashida K, Lefèvre T, Chevalier B, et al. Transfemoral aortic valve implantation new criteria to predict vascular complications. JACC Cardiovasc Interv, 2011, 4(8): 851-858.
21.	Drafts BC, Choi CH, Sangal K, et al. Comparison of outcomes with surgical cut-down versus percutaneous transfemoral transcatheter aortic valve replacement: TAVR transfemoral access comparisons between surgical cut-down and percutaneous approach. Catheter Cardiovasc Interv, 2018, 91(7): 1354-1362.
22.	Vora A, Rao SV. Percutaneous or surgical access for transfemoral transcatheter aortic valve implantation. J Thorac Dis, 2018, 10(Suppl 30): S3595-S3598.
23.	Konigstein M, Havakuk O, Arbel Y, et al. The obesity paradox in patients undergoing transcatheter aortic valve implantation. Clin Cardiol, 2015, 38(2): 76-81.
24.	Bernardi FL, Gomes WF, de Brito FS Jr, et al. Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry. Catheter Cardiovasc Interv, 2015, 86(3): 501-505.
25.	Ando T, Briasoulis A, Holmes AA, et al. Percutaneous versus surgical cut-down access in transfemoral transcatheter aortic valve replacement: a meta-analysis. J Card Surg, 2016, 31(12): 710-717.
26.	McCabe JM, Huang PH, Cohen DJ, et al. Surgical versus percutaneous femoral access for delivery of large-bore cardiovascular devices (from the PARTNER trial). Am J Cardiol, 2016, 117(10): 1643-1650.

1. Kanwar A, Thaden JJ, Nkomo VT. Management of patients with aortic valve stenosis. Mayo Clin Proc, 2018, 93(4): 488-508.
2. Carabello B, Paulus WJ. Aortic stenosis. Lancet, 2009, 373(9667): 956-966.
3. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): 450-500.
4. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
5. 张怡, 熊恬园, 陈茂. 《2021 ESC/EACTS 心脏瓣膜病管理指南》解读:经导管瓣膜治疗策略的更新. 中国胸心血管外科临床杂志, 2021, 28(12): 1400-1408.
6. Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement: part 1: basic anatomy, imaging, sheaths, wires, and access routes. JACC Cardiovasc Interv, 2013, 6(7): 643-653.
7. Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement part 2: vascular complications. JACC Cardiovasc Interv, 2013, 6(8): 767-776.
8. Walas RL, Kukulski L, Rychter J, et al. Vascular access site complications after transfemoral transcatheter aortic valve implantation in the POL-TAVI Registry: surgical versus percutaneous approach. J Cardiovasc Surg (Torino), 2020, 61(1): 117-122.
9. Spitzer SG, Wilbring M, Alexiou KA, et al. Surgical cut-down or percutaneous access which is best for less vascular access complications in transfemoral TAVI?. Catheter Cardiovasc Interv, 2016, 88(2): E52-E58.
10. Hernández-Enriquez M, Andrea R, Brugaletta S, et al. Puncture versus surgical cutdown complications of transfemoral aortic valve implantation (from the Spanish TAVI registry). Am J Cardiol, 2016, 118(4): 578-584.
11. Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J, 2012, 33(19): 2403-2418.
12. Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg, 2007, 133(5): 1226-1233.
13. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
14. Ducrocq G, Francis F, Serfaty JM, et al. Vascular complications of transfemoral aortic valve implantation with the Edwards SAPIEN prosthesis: incidence and impact on outcome. EuroIntervention, 2010, 5(6): 666-672.
15. Holmes DR Jr, Nishimura RA, Grover FL, et al. Annual outcomes with transcatheter valve therapy: from the STS/ACC TVT Registry. J Am Coll Cardiol, 2015, 66(25): 2813-2823.
16. Maniotis C, Andreou C, Karalis I, et al. A systematic review on the safety of Prostar XL versus ProGlide after TAVR and EVAR. Cardiovasc Revasc Med, 2017, 18(2): 145-150.
17. Giordano A, Corcione N, Ferraro P, et al. Comparison of ProGlide vs prostar in patients undergoing transcatheter aortic valve implantation. Minerva Cardioangiol, 2019, 67(6): 443-449.
18. Xiong TY, Li YJ, Feng Y, et al. Understanding the interaction between transcatheter aortic valve prostheses and supra-annular structures from post-implant stent geometry. JACC Cardiovasc Interv, 2019, 12(12): 1164-1171.
19. Manunga JM, Gloviczki P, Oderich GS, et al. Femoral artery calcification as a determinant of success for percutaneous access for endovascular abdominal aortic aneurysm repair. J Vasc Surg, 2013, 58(5): 1208-1212.
20. Hayashida K, Lefèvre T, Chevalier B, et al. Transfemoral aortic valve implantation new criteria to predict vascular complications. JACC Cardiovasc Interv, 2011, 4(8): 851-858.
21. Drafts BC, Choi CH, Sangal K, et al. Comparison of outcomes with surgical cut-down versus percutaneous transfemoral transcatheter aortic valve replacement: TAVR transfemoral access comparisons between surgical cut-down and percutaneous approach. Catheter Cardiovasc Interv, 2018, 91(7): 1354-1362.
22. Vora A, Rao SV. Percutaneous or surgical access for transfemoral transcatheter aortic valve implantation. J Thorac Dis, 2018, 10(Suppl 30): S3595-S3598.
23. Konigstein M, Havakuk O, Arbel Y, et al. The obesity paradox in patients undergoing transcatheter aortic valve implantation. Clin Cardiol, 2015, 38(2): 76-81.
24. Bernardi FL, Gomes WF, de Brito FS Jr, et al. Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry. Catheter Cardiovasc Interv, 2015, 86(3): 501-505.
25. Ando T, Briasoulis A, Holmes AA, et al. Percutaneous versus surgical cut-down access in transfemoral transcatheter aortic valve replacement: a meta-analysis. J Card Surg, 2016, 31(12): 710-717.
26. McCabe JM, Huang PH, Cohen DJ, et al. Surgical versus percutaneous femoral access for delivery of large-bore cardiovascular devices (from the PARTNER trial). Am J Cardiol, 2016, 117(10): 1643-1650.

West China Medical Journal

Comparison of surgical cutdown and percutaneous puncture in transcatheter aortic valve replacement

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