Surgical cut‐down or percutaneous access—which is best for less vascular access complications in transfemoral TAVI?

Objectives Objective of the present study was to compare VARC‐2 access and bleeding complications of a complete percutaneous versus a surgical cut‐down approach for transfemoral TAVI “in a real world‐all comers” setting. Background The ideal approach for transfemoral TAVI is still part of a lively debate. Until today, for none of the available techniques superiority could be demonstrated. The present study adds a considerable number of patients to the available experience. Methods: The study included 334 consecutive patients, including 199 patients in the percutaneous and 135 patients in the cut‐down group. Mean patient's age was 81.4 ± 4.6. Calculated logistic EuroSCORE correlated an intermediate to high surgical risk (17.8% ± 12.3%). Primary study endpoints were vascular access site as well as bleeding complications according the actual VARC‐2 criteria. Results Mean procedure time was significantly shorter in the cut‐down group (69 ± 19 min vs. 91 ± 22 min; P  < 0.01). Overall rate of VARC‐2 access complications were significantly more frequent in the percutaneous group ( n  = 41/199; 20.6% vs. n  = 11/135; 8.1%; P  = 0.04); the incidence of major complications did not differ significantly ( P  = 0.19). VARC‐2 bleeding complications were more frequent in the percutaneous group as well (18.1% vs. 4.4%; P  = 0.029). Hospital stay differed not significantly ( P  = 0.214). Hospital mortality was 3.5% in the percutaneous group and 1.5% in the cut‐down group ( P  = n.s.). Conclusion Surgical cut‐down provided a convenient and controlled access, resulting in less access and bleeding complications. Nontheless, major access complication differed not significantly. Both approaches must be seen as complementary techniques. A portfolio containing both techniques is the exclusive way to provide a tailor‐made and patient‐orientated approach. © 2015 Wiley Periodicals, Inc.