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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
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Cut-down outperforms complete percutaneous transcatheter valve implantation
Markus Mach1, Manuel Wilbring2, Bernhard Winkler1
11 Department of Cardiovascular Surgery, 31405 Hospital Hietzing and Karl Landsteiner Institute for Cardiovascular Research, Vienna, Austria.
Asian Cardiovascular & Thoracic Annals
|February 8, 2018
Summary
Surgical cut-down for transfemoral transcatheter aortic valve implantation offers safer access with fewer complications compared to the percutaneous approach. Both techniques are complementary, allowing for tailored patient care based on individual vessel conditions.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Transfemoral transcatheter aortic valve implantation (TAVI) approaches are debated.
- Optimizing access site management is crucial for TAVI outcomes.
Purpose of the Study:
- To compare vascular access and bleeding complications between complete percutaneous and surgical cut-down approaches for transfemoral TAVI.
Main Methods:
- A retrospective study of 667 patients undergoing transfemoral TAVI.
- Comparison of percutaneous (n=466) versus surgical cut-down (n=201) access.
- Vascular access and bleeding complications assessed using Valve Academic Research Consortium II criteria.
Main Results:
- Surgical cut-down had a shorter mean procedure time (69 min vs. 93.5 min).
- Percutaneous approach showed higher rates of access complications (20.4% vs. 8.5%) and bleeding complications (21.9% vs. 4.5%).
- Major access complications were not significantly different, but minor complications were higher in the percutaneous group.
Conclusions:
- Surgical cut-down provides more controlled access, leading to fewer access site and bleeding complications.
- Both percutaneous and surgical cut-down are complementary techniques for TAVI.
- A combined approach allows for patient-specific, safer access selection based on vessel condition.
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