Percutaneous vs. surgical axillary access for transcatheter aortic valve implantation: the TAXI registry.
Обработка статьи · этапы, ошибки и управление
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Giordano Arturo, Schaefer Andreas, Bhadra Oliver D, Conradi Lenard, Westermann Dirk, DE Backer Ole, Bajoras Vilhelmas, Sondergaard Lars, Qureshi Waqas T, Kakouros Nikolaos, Aldrugh Summer, Amat-Santos Ignacio, Santos Martínez Sandra, Kaneko Tsuyoshi, Harloff Morgan, Teles Rui, Nolasco Tiago, Neves Jose P, Abecasis Miguel, Werner Nikos, Lauterbach Michael, Sacha Jerzy, Krawczyk Krzysztof, Trani Carlo, Romagnoli Enrico, Mangieri Antonio, Condello Francesco, Regueiro Ander, Brugaletta Salvatore, Biancari Fausto, Niemelä Matti, Giannini Francesco, Toselli Marco, Ruggiero Rossella, Buono Andrea, Maffeo Diego, Bruno Francesco, Conrotto Federico, D'Ascenzo Fabrizio, Savontaus Mikko, Pykäri Jouni, Ielasi Alfonso, Tespili Maurizio, Corcione Nicola, Ferraro Paolo, Morello Alberto, Albanese Michele, Biondi-Zoccai Giuseppe
Аннотация
METHODS: We performed an international retrospective observational study using de-identified details on baseline, procedural, and 1-month follow-up features. Valve Academic Research Consortium (VARC)-3 criteria were applied throughout. Outcomes of interest were clinical events up to 1 month of follow-up, compared with unadjusted and propensity score-adjusted analyses.
RESULTS: A total of 432 patients were included, 189 (43.8%) receiving surgical access, and 243 (56.2%) undergoing percutaneous access. Primary hemostasis failure was more common in the percutaneous group (13.2% vs. 4.2%, P<0.001), leading to more common use of covered stent implantation (13.2% vs. 3.7%, P<0.001). Irrespectively, percutaneous access was associated with shorter hospital stay (-2.6 days [95% confidence interval: -5.0; -0.1], P=0.038), a lower risk of major adverse events (a composite of death, myocardial infarction, stroke, type 3 bleeding, and major access-site related complication; odds ratio=0.44 [0.21; 0.95], P=0.036), major access-site non-vascular complications (odds ratio=0.21 [0.06; 0.77], P=0.018), and brachial plexus impairment (odds ratio=0.16 [0.03; 0.76], P=0.021), and shorter hospital stay (-2.6 days [-5.0; -0.1], P=0.038).
CONCLUSIONS: Percutaneous axillary access provides similar or better results than surgical access in patients undergoing TAVI with absolute or relative contraindications to femoral access.