This article is more than 5 years old. Information may no longer be current.
Fully percutaneous TAVR approach associated with shorter length of stay
A fully percutaneous approach to balloon-expandable transcatheter aortic valve replacement was associated with shorter length of stay compared with the open surgical cutdown approach.
In unadjusted analysis, the fully percutaneous TAVR approach was associated with fewer major vascular complications compared with the open surgical approach, but a propensity-matched analysis revealed no difference between the groups.
Researchers analyzed 331 patients who underwent transfemoral TAVR with the Sapien or Sapien XT valves (Edwards Lifesciences) at the Hospital of the University of Pennsylvania between 2007 and 2013. Of those, 211 underwent the fully percutaneous approach and 120 the open surgical cutdown approach.
The primary endpoint was vascular complications at 30 days. Because assignment to the access approaches was not random, the researchers created propensity-matched cohorts based on sex, Society of Thoracic Surgeons risk score, BMI, left or right access and difference between sheath outer diameter and minimal artery diameter (ShOD-MAD). They also compared length of stay and in-hospital all-cause mortality based on the two approaches.
In the analysis before propensity matching, the fully percutaneous approach was associated with fewer major vascular complications (11% vs. 20%; P=.03) and shorter length of stay (7.5 days vs. 9.9 days; P=.003) compared with the open surgical approach. The researchers found no difference in in-hospital all-cause mortality (P=.36).
A multivariable regression analysis of all patients determined t
hat women were more likely to experience any vascular complications than men (OR=2.2; 95% CI, 1.1-4.3), and that larger differences between sheath outer diameter and minimal artery diameter were more likely to be associated with overall vascular complications (OR=1.4 for every 1 mm increase in ShOD-MAD; 95% CI, 1.1.-1.8) and major vascular complications (OR=2 for every 1 mm increase in ShOD-MAD; 95% CI, 1.4.-2.9), the researchers wrote.
In the analysis after propensity matching, there was no difference between the groups in major vascular complications (P=.7) or in in-hospital mortality (P=.25), but length of stay remained shorter for the fully percutaneous group (7.9 days vs. 10 days; P=.04).
The open surgical cutdown approach may be associated with longer length of stay despite not being associated with more major vascular complications “because of the increased recovery time and time to ambulation after a surgical cutdown and closure as opposed to percutaneous closure,” Mitul B. Kadakia, MD, from the divisions of cardiovascular medicine and cardiovascular surgery, Perelman School of Medicine at University of Pennsylvania, and colleagues wrote. “A [fully percutaneous] approach seems to be preferable from both an economic and a patient comfort perspective; however, additional study is necessary to assess whether reduced length of stay after [fully percutaneous] TAVR is associated with decreased costs and increased patient satisfaction.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.