Mousa Mohamed Ahmed, Zahwy Sherif Samir El, Tamara Ahmed Fathy, Samir Wafed, Tantawy Mahmoud Ahmed
Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Deaprtment of Cardiology, Faculty of Medicine, Misr University for Science and Technology, 6th of October, Egypt.
CVIR Endovasc. 2023 Oct 30;6(1):53. doi: 10.1186/s42155-023-00395-6.
Compared to conventional open surgery, minimally invasive catheter-based procedures have less post procedural complications. Transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (EVAR) require large bore arterial access. Optimal site management of large bore arterial access is pivotal to reduce the hospital-acquired complications associated with large bore arterial access. We wanted to compare surgical cutdown versus percutaneous closure devices in site management of large bore arterial access.
Participants planned for TAVI or EVAR with large bore arterial access more than 10 French were included, while participants with history of bypass surgery, malignancies, thrombophilia, or sepsis were excluded. A consecutive sample of 100 participants (mean age 74.66 ± 2.65 years, 61% males) was selected, underwent TAVI or EVAR with surgical cutdown (group 1) versus TAVI or EVAR with Proglide™ percutaneous closure device (group 2).
The incidence rate of hematoma was significantly lower in group 2 versus group 1 (p = 0.014), the mean procedure time (minutes) and the median hospital stay (days) were significantly higher in group 1 versus group 2 (t(98) = - 2.631, p = 0.01, and U = 2.403, p = 0.018, respectively), and the c-reactive protein pre-procedure and the c-reactive protein post-procedure were significantly lower in group 2 versus group 1 (U = -2.969, p = 0.003, and U = -2.674, p = 0.007, respectively).
Our study showed a lower incidence rate of large bore arterial access complications as hematoma, a shorter procedure time, and a shorter hospital stay with percutaneous closure devices compared to surgical cutdown.
与传统开放手术相比，基于导管的微创介入手术术后并发症更少。经导管主动脉瓣植入术（TAVI）和血管内动脉瘤修复术（EVAR）需要大口径动脉入路。大口径动脉入路的最佳部位管理对于减少与大口径动脉入路相关的医院获得性并发症至关重要。我们想要比较手术切开与经皮闭合装置在大口径动脉入路部位管理中的效果。
纳入计划接受TAVI或EVAR且大口径动脉入路超过10F的参与者，排除有搭桥手术史、恶性肿瘤、血栓形成倾向或败血症的参与者。选取连续的100名参与者样本（平均年龄74.66±2.65岁，61%为男性），分别接受手术切开的TAVI或EVAR（第1组）与使用Proglide™经皮闭合装置的TAVI或EVAR（第2组）。
第2组血肿发生率显著低于第1组（p = 0.014），第1组平均手术时间（分钟）和中位住院时间（天）显著高于第2组（t(98)= -2.631，p = 0.01；U = 2.403，p = 0.018），第2组术前和术后C反应蛋白显著低于第1组（U = -2.969，p = 0.003；U = -2.674，p = 0.007）。
我们的研究表明，与手术切开相比，经皮闭合装置导致的大口径动脉入路并发症如血肿的发生率更低，手术时间更短，住院时间更短。
