Surgical Versus Percutaneous Femoral Access for Delivery of Large-Bore Cardiovascular Devices (from the PARTNER Trial)

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• 作者：James M. McCabe ; MD^a ; ^{jmmccabe@uw.edu" class="auth_mail" title="E-mail the corresponding author} ; Pei-Hsiu Huang ; MD^b ; David J. Cohen ; MD ; MSc^c ; Eugene H. Blackstone ; MD^d ; Frederick G.P. Welt ; MD^e ; Michael J. Davidson ; MD^f ; ^&dagger ; ; Tsuyoshi Kaneko ; MD^f ; Marvin H. Eng ; MD^g ; Keith B. Allen ; MD^c ; Ke Xu ; PhD^h ; Ashley M. Lowry ; MS^d ; Yang Lei ; MS^c ; Jeevanantham Rajeswaran ; PhD^d ; David L. Brown ; MDⁱ ; Michael J. Mack ; MD^j ; John G. Webb ; MD^k ; Craig R. Smith ; MD^l ; Martin B. Leon ; MD^m ; Andrew C. Eisenhauer ; MDⁿ ; ^o ; on behalf of the PARTNER Trial Investigators
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：15 May 2016
• 年：2016
• 卷：117
• 期：10
• 页码：1643-1650
• 全文大小：749 K

文摘

It is unclear if surgical exposure confers a risk advantage compared with a percutaneous approach for patients undergoing endovascular procedures requiring large-bore femoral artery access. From the randomized controlled Placement of Aortic Transcatheter Valve trials A and B and the continued access registries, a total of 1,416 patients received transfemoral transcatheter aortic valve replacement, of which 857 underwent surgical, and 559 underwent percutaneous access. Thirty-day rates of major vascular complications and quality of life scores were assessed. Propensity matching was used to adjust for unmeasured confounders. Overall, there were 116 major vascular complications (8.2%). Complication rates decreased dramatically during the study period. In unadjusted analysis, major vascular complications were significantly less common in the percutaneous access group (35 [6.3%] vs 81 [9.5%] p = 0.032). However, among 292 propensity-matched pairs, there was no difference in major vascular complications (22 [7.5%] vs 28 [9.6%], p = 0.37). Percutaneous access was associated with fewer total in-hospital vascular complications (46 [16%] vs 66 [23%], p = 0.036), shorter median procedural duration (97 interquartile range [IQR 68 to 166] vs 121 [IQR 78 to 194] minutes, p <0.0001), and median length of stay (4 [IQR 2 to 8] vs 6 [IQR 3 to 10] days, p <0.0001). There were no significant differences in quality of life scores at 30 days. Surgical access for large-bore femoral access does not appear to confer any advantages over percutaneous access and may be associated with more minor vascular complications.