ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
A comparison of conventional surgery versus a vascular closure device for femoral artery repair following transcatheter aortic valve replacement
Mehmet Beşir Akpınar1, İlker Gül2, Veysel Şahin1, Ahmet Taştan2, İhsan Sami Uyar1, Halil Uç1, İlker Kiriş1, Faik Fevzi Okur1
1Departments of Cardiovascular Surgery, Medical Faculty of Şifa University, İzmir, Turkey
2Departments of Cardiology, Medical Faculty of Şifa University, İzmir, Turkey
DOI : 10.5606/tgkdc.dergisi.2016.12821
Background: This study aims to compare the results of a percutaneous closure device versus conventional surgery for femoral artery access site closure during transcatheter aortic valve implantation.

Methods: Between June 2013 and September 2015, a total of 111 consecutive patients (56 males, 55 females; mean age 77.7±7.4 years; range, 52 to 95 years) who underwent transcatheter aortic valve implantation via transfemoral artery access were included in the study. Femoral artery access site was closed by a percutaneous closure device in 67 patients (60.4%) and by conventional surgery in 44 patients (39.6%). Safety and efficiency of both techniques were assessed in terms of the complications, re-interventions, and re-hospitalizations during the postoperative 30 days.

Results: Four patients (6%) experienced technical complications with the percutaneous closure device. A total of 53 (79.1%) patients in the percutaneous closure device group and 42 (95.5%) patients in the conventional surgery group achieved technical success without any need for re-intervention. A significantly higher number of percutaneous closure device patients experienced total vascular complications [22 (32.9%) vs 5 (11.4%); p=0.012] and needed secondary vascular interventions [12 (17.9%) vs 2 (4.6%); p=0.043], [emergency surgical intervention 2 (3%), percutaneous balloon angioplasty 12 (17.9%), and graft-stent implantation 7 (10.4%)], compared to the conventional surgery group. However, the rate of postprocedural wound complications, including lymphorrhea and infection, was higher [15 (34%) vs 6 (9%)] and the length of hospital stay was longer in conventional surgery group (4.7±1.2 vs 4.2±1.6 days; p=0.04).

Conclusion: Our study findings suggest that conventional surgery is more effective and safer than the percutaneous closure device for femoral artery access site closure during transcatheter aortic valve implantation procedures with a lower rate of periprocedural complications and re-interventions. In contrast, femoral artery access site closure by a percutaneous closure device seems to be associated with less postprocedural wound site complications than conventional surgery.

Keywords : Endovascular intervention; percutaneous closure; transcatheter aortic valve implantation; vascular complication
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