Background Third-generation transcatheter heart valves (THV) are predominantly implanted through a percutaneous, transfemoral access. To reduce vascular complications, we selectively performed surgical vascular access (cutdown) in patients with particular calcified or small femoral arteries. We aim to review our experience with this approach.

Methods All patients who underwent transfemoral transcatheter aortic valve replacement (TAVR) with a third-generation THV at our institution between March 2014 and April 2019 were included in the study. All available computerized tomography studies were reassessed for access vessel diameter and visual graduation of calcifications. Vascular complications are reported according to Valve Academic Research Consortium-2 criteria.

Results A total of 944 patients were included. Among them, 879 patients underwent a percutaneous access and 65 patients underwent surgical cutdown. Also, 459 Evolut R/PRO and 420 Sapien 3/ultra were implanted percutaneously and 40 Evolut R/PRO and 25 Sapien 3 were implanted with a surgical cutdown. Patients with surgical cutdown were older (80.0 ± 7.5 vs. 83.8 ± 7.5 years, p < 0.001), had smaller femoral arteries (8.0 ± 1.6 vs. 7.6 ± 1.6 mm, p = 0.034) and more severe vessel calcifications (17.5 vs. 1.0%, p < 0.001). Procedure time was similar for cutdown and percutaneous access (64.0 vs. 64.5 minutes, p = 0.879). With percutaneous access, 80 major vascular complications (10%) occurred, whereas with surgical cutdown, no major vascular complications occurred (p < 0.005). No wound infection occurred after surgical cutdown. The mean length of stay was 8 days in both groups.

Conclusion Surgical cutdown for vascular access avoids vascular complications in patients with small or severely calcified femoral arteries.

背景 第三代经导管心脏瓣膜 (THV) 主要通过经皮、经股动脉通路植入。为了减少血管并发症，我们选择性地对患有特定钙化或小股动脉的患者进行了手术血管通路（切断）。我们的目标是回顾我们使用这种方法的经验。

方法 2014 年 3 月至 2019 年 4 月在我院接受第三代 THV 经股动脉经导管主动脉瓣置换术（TAVR）的所有患者均纳入研究。重新评估所有可用的计算机断层扫描研究的通路血管直径和钙化的视觉分级。根据 Valve Academic Research Consortium-2 标准报告血管并发症。

结果 共纳入944例患者。其中，879名患者接受了经皮通路，65名患者接受了手术切开。此外，459 Evolut R/PRO 和 420 Sapien 3/ultra 经皮植入，40 Evolut R/PRO 和 25 Sapien 3 通过手术切开植入。接受手术切除的患者年龄较大（80.0 ± 7.5 vs. 83.8 ± 7.5 岁，p  < 0.001），股动脉较小（8.0 ± 1.6 vs. 7.6 ± 1.6 mm，p  = 0.034）和更严重的血管钙化（17.5 vs. 1.0%，p  < 0.001）。切开和经皮通路的手术时间相似（64.0 与 64.5 分钟，p = 0.879）。经皮通路发生 80 种主要血管并发症（10%），而手术切开术未发生主要血管并发症（p  < 0.005）。手术切开后未发生伤口感染。两组的平均住院时间均为 8 天。

结论 手术切断血管通路可避免股动脉小或严重钙化患者的血管并发症。