Refereed journal article or data article (A1)
Percutaneous vs. surgical axillary access for transcatheter aortic valve implantation: the TAXI registry
List of Authors: Giordano Arturo, Schaefer Andrea, Bhadra Oliver D, Conradi Lenard, Westermann Dirk, DE Backer Ole, Bajoras Vilhelmas, Sondergaard Lars, Qureshi Wagas T, Kakouros Nikolas, Aldrugh Summer, Amat-Santos Ignacio, Santos Martínez Sandra, Kaneko Tsuyoshi, Harloff Morgan, Teles Rrui, Nolasco Tiago, Neves Jose P, Abecasis Miguel, Werner Nikos, Lauterbach Michael, Sacha Jerzy, Krawczyk Krysztof, Trani Carlo, Romagnoli Enrico, Mangieri Antonio, Condello Francesco, Regueiro Ander, Brugaletta Salvatore, Biancari Fausto, Niemelä Matti, Giannini Francesco, Toselli Marco, Ruggiero Rosella, Buono Anderea, Maffeo Ddiego, Bruno Francesco, Conrotto Frederico, D'Ascenzo Fabrizio, Savontaus Mikko, Pykäri Jouni, Ielasi Alfonso, Tespili Maurizio, Corcione Nicola, Ferraro Paolo, Morello Albergo, Albanese Michele, Biondi-Zoccai Giuseppe
Publisher: Edizoni Minerva Medica
Publication year: 2022
Journal: Panminerva Medica
Volume number: 64
Issue number: 4
Start page: 427
End page: 437
DOI: http://dx.doi.org/10.23736/S0031-0808.22.04750-4
Background: Transcatheter aortic valve implantation (TAVI) is an established management strategy for severe aortic valve stenosis. Percutaneous axillary approach for TAVI holds the promise of improving safety without jeopardizing effectiveness in comparison to surgical access. We aimed at appraising the comparative effectiveness of percutaneous vs. surgical axillary approaches for TAVI.
Methods: We performed an international retrospective observational study using de-identified details on baseline, procedural, and 1-month follow-up features. Valve Academic Research Consortium (VARC)-3 criteria were applied throughout. Outcomes of interest were clinical events up to 1 month of follow-up, compared with unadjusted and propensity score-adjusted analyses.
Results: A total of 432 patients were included, 189 (43.8%) receiving surgical access, and 243 (56.2%) undergoing percutaneous access. Primary hemostasis failure was more common in the percutaneous group (13.2% vs. 4.2%, P<0.001), leading to more common use of covered stent implantation (13.2% vs. 3.7%, P<0.001). Irrespectively, percutaneous access was associated with shorter hospital stay (-2.6 days [95% confidence interval: -5.0; -0.1], P=0.038), a lower risk of major adverse events (a composite of death, myocardial infarction, stroke, type 3 bleeding, and major access-site related complication; odds ratio=0.44 [0.21; 0.95], P=0.036), major access-site non-vascular complications (odds ratio=0.21 [0.06; 0.77], P=0.018), and brachial plexus impairment (odds ratio=0.16 [0.03; 0.76], P=0.021), and shorter hospital stay (-2.6 days [-5.0; -0.1], P=0.038).
