PDF(Pubmed)
Abstract：
Background: The transfemoral (TF) approach is the most common route in TAVI, but it is still associated with a risk of bleeding and vascular complications. The aim of this study was to compare the clinical outcomes between surgical cut-down (SC) and percutaneous (PC) approach. (2) Methods: Between January 2018 and June 2022, 774 patients underwent a transfemoral TAVI procedure. After propensity matching, 323 patients underwent TAVI in each group. (3) Results: In the matched population, 15 patients (4.6%) in the SC group vs. 34 patients in the PC group (11%) experienced minor vascular complications (p = 0.02), while no difference for major vascular complication (1.5% vs. 1.9%) were reported. The rate of minor bleeding events was higher in the percutaneous group (11% vs. 3.1%, p <.001). The SC group experienced a higher rate of non-vascular-related access complications (minor 8% vs. 1.2%; major 2.2% vs. 1.2%; p < 0.001). (4) Conclusions: SC for TF-TAVI did not alter the mortality rate at 30 days and was associated with reduced minor vascular complication and bleeding. PC showed a lower rate of non-vascular-related access complications and a lower length of stay. The specific approach should be tailored to the patient\'s clinical characteristics.
摘要：
背景：经股动脉（TF）入路是TAVI中最常见的入路，但它仍然与出血和血管并发症的风险有关。这项研究的目的是比较手术切除（SC）和经皮（PC）方法之间的临床结果。（2）方法：2018年1月至2022年6月，774例患者接受了经股动脉TAVI手术。在倾向匹配之后，每组323例患者行TAVI。(3)结果：在匹配人群中，SC组的15例患者（4.6％）与PC组34例患者（11%）出现轻微血管并发症（p=0.02），而主要血管并发症没有差异(1.5%与1.9%）报告。经皮组中轻微出血事件的发生率较高(11%vs.3.1%,p<.001)。SC组的非血管相关通路并发症发生率较高(轻微为8%vs.1.2%；主要2.2%与1.2%；p<0.001）。（4）结论：TF-TAVI的SC没有改变30天的死亡率，并且与减少的小血管并发症和出血有关。PC显示出非血管相关通路并发症的发生率较低，住院时间较短。具体方法应根据患者的临床特征进行调整。
