Eckner Dennis, Pollari Francesco, Santarpino Giuseppe, Jessl Jürgen, Schwab Johannes, Martinovic Kristinko, Mair Helmut, Pauschinger Matthias, Fischlein Theodor, Vogt Ferdinand
Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany.
Department of Cardiac Surgery, Paracelsus Medical University, 90471 Nuremberg, Germany.
J Clin Med. 2021 Mar 24;10(7):1344. doi: 10.3390/jcm10071344.
The vascular access in transcatheter aortic valve replacement (TAVR) was initially dominated by a surgical approach. Meanwhile, percutaneous closure systems became a well-established alternative. The aim of this study was to compare the clinical outcome between the two approaches.
In this retrospective study, we observed 787 patients undergoing a TAVR-Procedure between 2013 and 2019. Of those, 338 patients were treated with surgical access and 449 with the Perclose ProGlide™-System (Abbott, Chicago, IL, USA). According to the Bleeding Academic Research Consortium (BARC) and Valve Academic Research Consortium (VARC) criteria, the primary combined endpoints were defined.
Overall hospital mortality was 2.8% with no significant difference between surgical (3.8%) and percutaneous (2.2%) access ( = 0.182). Major vascular complications or bleeding defined as the primary combined endpoint was not significantly different in either group (Surgical group 5.3%, ProGlide group 5.1%, = 0.899). In the ProGlide group, women with pre-existing peripheral artery disease (PAD) were significantly more often affected by a vascular complication ( = 0.001 for female sex and = 0.03 for PAD).
We were able to show that the use of both accesses is safe. However, the surgical access route should also be considered in case of peripheral artery disease.
经导管主动脉瓣置换术（TAVR）中的血管通路最初主要采用外科手术方法。与此同时，经皮闭合系统已成为一种成熟的替代方法。本研究的目的是比较这两种方法的临床结果。
在这项回顾性研究中，我们观察了2013年至2019年间接受TAVR手术的787例患者。其中，338例患者采用外科手术通路治疗，449例患者采用Perclose ProGlide™系统（美国伊利诺伊州芝加哥市雅培公司）治疗。根据出血学术研究联盟（BARC）和瓣膜学术研究联盟（VARC）的标准定义主要联合终点。
总体医院死亡率为2.8%，外科手术通路组（3.8%）和经皮通路组（2.2%）之间无显著差异（P = 0.182）。定义为主要联合终点的主要血管并发症或出血在两组中均无显著差异（手术组5.3%，ProGlide组5.1%，P = 0.899）。在ProGlide组中，既往有外周动脉疾病（PAD）的女性更常发生血管并发症（女性P = 0.001，PAD P = 0.03）。
我们能够证明两种通路的使用都是安全的。然而，在外周动脉疾病的情况下也应考虑外科手术通路。
