Comparison between Surgical Access and Percutaneous Closure Device in 787 Patients Undergoing Transcatheter Aortic...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Surgical Innovation

Background:

• Transcatheter aortic valve replacement (TAVR) initially relied on surgical vascular access.
• Percutaneous closure systems have emerged as a viable alternative for TAVR vascular access.
• Clinical outcomes of surgical versus percutaneous access in TAVR require comparative analysis.

Purpose of the Study:

• To compare the clinical outcomes of surgical vascular access versus percutaneous closure systems in TAVR.
• To evaluate safety and efficacy between the two primary vascular access methods for TAVR.

Main Methods:

• Retrospective study of 787 patients undergoing TAVR between 2013 and 2019.
• Comparison of 338 patients with surgical access against 449 patients using the Perclose ProGlide™-System.
• Primary endpoints defined by Bleeding Academic Research Consortium (BARC) and Valve Academic Research Consortium (VARC) criteria.

Main Results:

• No significant difference in overall hospital mortality between surgical (3.8%) and percutaneous (2.2%) access (p=0.182).
• Major vascular complications or bleeding rates were similar: 5.3% for surgical and 5.1% for ProGlide (p=0.899).
• Women with peripheral artery disease (PAD) experienced significantly more vascular complications with ProGlide access (p=0.001 for sex, p=0.03 for PAD).

Conclusions:

• Both surgical and percutaneous vascular access methods are safe for TAVR procedures.
• Surgical access may be a more suitable option for TAVR patients with pre-existing peripheral artery disease.
• Further consideration of patient-specific factors like PAD is warranted for optimal TAVR access selection.