Puncture Versus Surgical Cutdown Complications of Transfemoral Aortic Valve Implantation (from the Spanish TAVI Registry)
Por:
Hernandez-Enriquez, M, Andrea, R, Brugaletta, S, Jimenez-Quevedo, P, Hernandez-Garcia, JM, Trillo, R, Larman, M, Fernandez-Aviles, F, Vazquez-Gonzalez, N, Iniguez, A, Zueco, J, Ruiz-Salmeron, R, del Valle, R, Molina, E, del Blanco, BG, Berenguer, A, Valdes, M, Moreno, R, Urbano-Carrillo, C, Hernandez-Antolin, R, Gimeno, F, Cequier, A, Cruz, I, Lopez-Minguez, JR, Aramendi, JI, Sanchez, A, Goicolea, J, Albarran, A, Diaz, JF, Navarro, F, Moreu, J, Morist, A, Fernandez-Nofrerias, E, Fernandez-Vazquez, F, Ten, F, Mainar, V, Mari, B, Saenz, A, Alfonso, F, Diarte, JA, Sancho, M, Lezaun, R, Arzamendi, D, Sabate, M
Publicada:
15 ago 2016
Resumen:
Vascular complications in transcatheter aortic valve implantation using transfemoral approach are related to higher mortality. Complete percutaneous approach is currently the preferred technique for vascular access. However, some centers still perform surgical cutdown. Our purpose was to determine complications related to vascular access technique in the population of the Spanish TAVI National Registry. From January 2010 to July 2015, 3,046 patients were included in this Registry. Of them, 2,465 underwent transfemoral approach and were treated with either surgical cutdown and closure (cutdown group, n = 632) or percutaneous approach (puncture group, n = 1,833). Valve Academic Research Consortium-2 definitions were used to assess vascular and bleeding complications. Propensity matching resulted in 615 matched pairs. Overall, 30-day vascular complications were significantly higher in the puncture group (109 [18%] vs 42 [6.9%]; relative risk [RR] 2.60; 95% confidence interval [CI] 1.85 to 3.64, p <0.001) due mostly by minor vascular events (89 [15%] vs 25 [4.1%], RR 3.56, 95% CI 2.32 to 5.47, p <0.001). Bleeding rates were lower in the puncture group (18 [3%] vs 40 [6.6%], RR 0.45, 95% CI 0.26 to 0.78, p = 0.003) mainly driven by major bleeding (9 [1.5%] vs 21 [3.4%], RR 0.43, 95% CI 0.20 to 0.93, p = 0.03). At a mean follow-up of 323 days, complication rates remained significantly different between groups (minor vascular complications 90 [15%] vs 31 [5.1%], hazard ratio 2.99, 95% CI 1.99 to 4.50, p <0.001 and major bleeding 10 [1.6%] vs 21 [3.4%], hazard ratio 0.47, 95% CI 0.22 to 1.0, p = 0.04, puncture versus cutdown group, respectively). In conclusion, percutaneous approach yielded higher rates of minor vascular complications but lower rates of major bleeding compared with the surgical cutdown, both at 30-day and at mid-term follow-up in our population. (C) 2016 Elsevier Inc. All rights reserved.
Filiaciones:
Hernandez-Enriquez, M:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Dept Cardiol, Hosp Clin Barcelona, Barcelona, Spain
Andrea, R:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Dept Cardiol, Hosp Clin Barcelona, Barcelona, Spain
Brugaletta, S:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Dept Cardiol, Hosp Clin Barcelona, Barcelona, Spain
Jimenez-Quevedo, P:
Hosp Clin San Carlos, Dept Cardiol, Madrid, Spain
Hernandez-Garcia, JM:
Hosp Virgen de la Victoria, Dept Cardiol, Malaga, Spain
Trillo, R:
Complejo Hosp Santiago de Compostela, Dept Cardiol, Santiago De Compostela, Spain
Larman, M:
Policlin Guipuzcoa, Dept Cardiol, San Sebastian, Spain
Fernandez-Aviles, F:
Hosp Gregorio Maranon, Dept Cardiol, Madrid, Spain
Vazquez-Gonzalez, N:
Complejo Hosp Univ A Coruna, Dept Cardiol, Coruna, Spain
Iniguez, A:
Complejo Hosp Univ Vigo Meixoeiro, Dept Cardiol, Vigo, Spain
Zueco, J:
Hosp Marques de Valdecilla, Dept Cardiol, Santander, Spain
Ruiz-Salmeron, R:
Hosp Virgen de la Macarena, Dept Cardiol, Seville, Spain
del Valle, R:
Hosp Univ Cent Asturias, Dept Cardiol, Oviedo, Spain
Molina, E:
Hosp Virgen de las Nieves, Dept Cardiol, Granada, Spain
del Blanco, BG:
Hosp Valle De Hebron, Dept Cardiol, Barcelona, Spain
Berenguer, A:
Hosp Gen Valencia, Dept Cardiol, Valencia, Spain
Valdes, M:
Hosp Virgen Arrixaca, Dept Cardiol, Murcia, Spain
Moreno, R:
Hosp La Paz, Dept Cardiol, Madrid, Spain
Urbano-Carrillo, C:
Hosp Reg Univ Carlos Haya, Dept Cardiol, Malaga, Spain
Hernandez-Antolin, R:
Hosp Ramon & Cajal, Dept Cardiol, Madrid, Spain
Gimeno, F:
Hosp Clin Valladolid, Dept Cardiol, Valladolid, Spain
Cequier, A:
Hosp Univ Bellvitge, Dept Cardiol, Barcelona, Spain
Cruz, I:
Complejo Hosp Salamanca, Cardiol Dept, Salamanca, Spain
Lopez-Minguez, JR:
Hosp Univ Infanta Cristina, Dept Cardiol, Badajoz, Spain
Aramendi, JI:
Hosp Cruces, Cardiovasc Surg Dept, Bilbao, Spain
Sanchez, A:
Hosp Virgen del Rocio, Dept Cardiol, Seville, Spain
Goicolea, J:
Hosp Majadahonda Puerta de Hierro, Dept Cardiol, Madrid, Spain
Albarran, A:
Hosp 12 Octubre, Dept Cardiol, Madrid, Spain
Diaz, JF:
Hosp Juan Ramon Jimenez, Dept Cardiol, Huelva, Spain
Navarro, F:
Fdn Jimenez Diaz, Dept Cardiol, Madrid, Spain
Moreu, J:
Hosp Virgen de la Salud, Dept Cardiol, Toledo, Spain
Morist, A:
Hosp Basurto, Dept Cardiol, Bilbao, Spain
Fernandez-Nofrerias, E:
Hosp Badalona Germans Trias & Pujol, Dept Cardiol, Badalona, Spain
Fernandez-Vazquez, F:
Hosp Univ Leon, Dept Cardiol, Leon, Spain
Ten, F:
Hosp La Fe, Dept Cardiol, Valencia, Spain
Mainar, V:
Hosp Gen Alicante, Dept Cardiol, Alicante, Spain
Mari, B:
Complejo Hosp Univ Canarias, Dept Cardiol, Santa Cruz De Tenerife, Spain
Saenz, A:
Clin Los Manzanos, Dept Cardiol, Logrono, Spain
Alfonso, F:
Hosp La Princesa, Dept Cardiol, Madrid, Spain
Diarte, JA:
Hosp Miguel Servet, Dept Cardiol, Zaragoza, Spain
Sancho, M:
Hosp Univ Puerta del Mar, Dept Cardiol, Cadiz, Spain
Lezaun, R:
Hosp Navarra, Dept Cardiol, Pamplona, Spain
Arzamendi, D:
Hosp Santa Creu & Sant Pau, Dept Cardiol, Barcelona, Spain
Sabate, M:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Dept Cardiol, Hosp Clin Barcelona, Barcelona, Spain
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