Related Experiment Video
Updated: Nov 15, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Proper Selection Does Make the Difference: A Propensity-Matched Analysis of Percutaneous and Surgical Cut-Down
Marco Gennari1, Marta Rigoni2,3, Giorgio Mastroiacovo1
1Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy.
Insights
Transcatheter aortic valve replacement (TAVR) via percutaneous femoral access resulted in shorter hospital stays and better survival rates compared to surgical cut-down TAVR. Pre-procedure femoral access assessment is crucial for successful transfemoral TAVR outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Transcatheter aortic valve replacement (TAVR) is a key treatment for severe symptomatic aortic stenosis across various surgical risks.
- The common femoral artery is the preferred access route for TAVR procedures.
- This study compares percutaneous and surgical cut-down transfemoral TAVR approaches.
Purpose of the Study:
- To compare the outcomes of percutaneous versus surgical cut-down transfemoral TAVR.
- To evaluate procedural success, length of hospital stay, discharge disposition, and survival rates between the two TAVR access methods.
Main Methods:
- An observational study analyzed 511 consecutive elective transfemoral TAVR patients from January 2014 to January 2019.
- Propensity score-matching created two homogeneous groups: surgical cut-down (n=119) and percutaneous (n=225).
- Patient demographics, EuroSCORE II, hemodynamic data, and outcomes were compared.
Main Results:
- No significant differences in procedural outcomes were observed between the percutaneous and surgical cut-down groups.
- Patients undergoing percutaneous TAVR (Group 2) experienced shorter hospital stays and higher rates of home discharge.
- Follow-up data indicated lower survival rates in the surgical cut-down group (Group 1).
Conclusions:
- Accurate preoperative assessment of femoral access is essential for successful transfemoral TAVR.
- The percutaneous approach offers advantages including shorter hospital stays and reduced need for rehabilitation, potentially lowering procedure costs.
Background:
Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosis patients with a wide range of surgical risk. Currently, the common femoral artery is the first choice as the main access route for the procedure. The objective of this observational study is to report our experience on percutaneous and surgical cut-down transfemoral TAVRs comparing the two approaches.
Methods:
From January 2014 to January 2019, five hundred eleven consecutive patients underwent TAVR for severe symptomatic aortic stenosis. We analyzed only elective transfemoral procedures. After propensity score-matching based on age, sex, EuroSCORE II, mean aortic gradient, and left ventricular ejection fraction, we obtained two homogeneous populations: surgical cut-down (n = 119) and percutaneous (n = 225), which were labeled Group 1 and Group 2, respectively.
Results:
The main findings were that there were no significant procedural outcome differences between the two groups, but Group 2 patients had a shorter length of hospital stay and were more frequently discharged home. At follow-up, Group 1 patients had lower survival rates.
Conclusions:
An accurate preoperative assessment of the femoral access is mandatory to achieve satisfactory outcomes with transfemoral TAVRs. Nevertheless, the percutaneous approach allows shorter in-hospital stay and the need for rehabilitation, thus potentially decreasing the costs of the procedure.
