Complete percutaneous approach for arterial access in transfemoral transcatheter aortic valve replacement: a comparison with surgical cut-down and closure

Catheter Cardiovasc Interv. 2014 Aug 1;84(2):293-300. doi: 10.1002/ccd.25130. Epub 2014 Apr 30.


Objectives: This study sought to investigate the immediate safety and feasibility of complete percutaneous access/closure of arteriotomy for device deployment compared to the surgical approach for transfemoral transcatheter aortic valve replacement (TAVR).

Background: The percutaneous approach for arterial access for device deployment in transfemoral TAVR is a potential alternative to the surgical approach.

Methods: In 274 patients who underwent transfemoral TAVR using Edward Sapien heart valve, 140 had a complete percutaneous approach using a "pre-closure" technique whereas 134 had surgical cut-down/repair for arterial access/closure of device deployment. Immediate vascular access/closure success, associated complications and clinical outcomes were compared.

Results: While overall acute success of access/closure and in-hospital access-related events were similar, significant isolated stenosis/dissection at the access site developed more frequently in the percutaneous group (7.1% vs. 0.7%, P = 0.007). Contrary, wound infections requiring prolonged antibiotics use or surgical debridement occurred more frequently in the surgical group (0.7% vs. 6.7%, P = 0.007). Although the rate of major vascular complications was not different, the surgical group developed more frequent minor bleeding (27.1% vs. 38.8%, P = 0.04) and underwent transfusion of packed red blood cells of ≤3 units (25.7% vs. 43.3%, P = 0.002). Median hospital stay was shorter in the percutaneous group (3 days vs. 4 days, P = 0.002).

Conclusions: The percutaneous approach is a feasible access/closure method with a potential of lowering access site infection and bleeding, and shortening hospital stay, while maintaining similar rates of major vascular complications compared to the surgical approach.

Keywords: TAVR; pre-closure; vascular complications.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / therapy*
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / instrumentation
  • Cardiac Catheterization / methods*
  • Debridement
  • Erythrocyte Transfusion
  • Feasibility Studies
  • Female
  • Femoral Artery / surgery*
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / instrumentation
  • Heart Valve Prosthesis Implantation / methods*
  • Hemorrhage / etiology
  • Hemorrhage / therapy
  • Hemostatic Techniques*
  • Humans
  • Length of Stay
  • Male
  • Prosthesis Design
  • Punctures
  • Reoperation
  • Retrospective Studies
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / therapy
  • Time Factors
  • Treatment Outcome


  • Anti-Bacterial Agents