Percutaneous transfemoral approach and additional vascular access selection influence hospital stay and survival after transcatheter aortic valve implantation

    Authors

    Keywords

    transcatheter aortic valve implantation, vascular access, complications

    DOI

    https://doi.org/10.15836/ccar2021.36

    Full Text

    Background : Transcatheter aortic valve implantation (TAVI) was proved to be a preferred method of severe aortic stenosis treatment in patients with medium and high surgical risk. However, that significant superiority over surgery is maintained only if femoral approach is possible. ( 1 ) Aim: We analyzed changes of approach to TAVI implantation before and after the introduction of percutaneous transfemoral implantation, together with data on 12-months survival, complications and hospital stay. Results : Among a total of 149 patients who received TAVI in our center, there were 94 implantations before and 55 implantations after the introduction of routine percutaneous implantation when it is feasible (with surgical cut-down reserved only for patients with peripheral artery disease). There were no significant differences in patients’ characteristics and risk factors among patients operated during two different periods. All 82 femoral procedures during the first period were performed with surgical cut-down, in addition to 9 transapical and 2 transaortic implantations. In the second period, there were 54 femoral implantations (30 with surgical cut down and 24 full percutaneous) and 1 transapical implantation. 12-month mortality (16% vs 7%), and median duration of hospitalization (10 vs 8 days) were lower among patients treated in the second period. However, there were more vascular complications in the second period (2% vs 9%), that were mostly resolved during the procedure, or within one day. Conclusions : After the introduction of full percutaneous approach to TAVI we observed a decrease in postoperative mortality, and reduction of hospital stay length, most probably due to significant decrease in relative proportion of transapical approach and routine surgical cut-down. Relative increase in vascular complications due to persistent selection of transfemoral approach in patients with challenging vascular access did not result in prolonged hospital stay or excess mortality. Future strategies for TAVI, especially during and after the pandemic era, will most probably favor fast-track approach, leaving hospital resources readily and longer available mainly for the most complicated patients.

    Cardiologia Croatica
    Back to search

    Percutaneous transfemoral approach and additional vascular access selection influence hospital stay and survival after transcatheter aortic valve implantation

    Extended Abstract
    Issue1-2
    Published
    Pages36
    PDF via DOIhttps://doi.org/10.15836/ccar2021.36
    transcatheter aortic valve implantation
    vascular access
    complications

    Authors

    Irzal Hadžibegović*ORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Danijel UnićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Ivana JurinORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Nikola BradićUniversity Hospital Dubrava, Zagreb, Croatia
    Boris StarčevićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Igor RudežORCIDUniversity Hospital Dubrava, Zagreb, Croatia

    Full Text

    Background : Transcatheter aortic valve implantation (TAVI) was proved to be a preferred method of severe aortic stenosis treatment in patients with medium and high surgical risk. However, that significant superiority over surgery is maintained only if femoral approach is possible. ( 1 ) Aim: We analyzed changes of approach to TAVI implantation before and after the introduction of percutaneous transfemoral implantation, together with data on 12-months survival, complications and hospital stay. Results : Among a total of 149 patients who received TAVI in our center, there were 94 implantations before and 55 implantations after the introduction of routine percutaneous implantation when it is feasible (with surgical cut-down reserved only for patients with peripheral artery disease). There were no significant differences in patients’ characteristics and risk factors among patients operated during two different periods. All 82 femoral procedures during the first period were performed with surgical cut-down, in addition to 9 transapical and 2 transaortic implantations. In the second period, there were 54 femoral implantations (30 with surgical cut down and 24 full percutaneous) and 1 transapical implantation. 12-month mortality (16% vs 7%), and median duration of hospitalization (10 vs 8 days) were lower among patients treated in the second period. However, there were more vascular complications in the second period (2% vs 9%), that were mostly resolved during the procedure, or within one day. Conclusions : After the introduction of full percutaneous approach to TAVI we observed a decrease in postoperative mortality, and reduction of hospital stay length, most probably due to significant decrease in relative proportion of transapical approach and routine surgical cut-down. Relative increase in vascular complications due to persistent selection of transfemoral approach in patients with challenging vascular access did not result in prolonged hospital stay or excess mortality. Future strategies for TAVI, especially during and after the pandemic era, will most probably favor fast-track approach, leaving hospital resources readily and longer available mainly for the most complicated patients.