A Comparative Study between Surgical Cut Down and Percutaneous Closure Devices in Management of Large Bore Arterial Access Used in Structural Heart and Endovascular Interventional Procedures

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Abstract Background Compared to conventional open surgery, minimally invasive catheter-based procedures including transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (EVAR) have less post procedural complications. TAVI and EVAR require large bore arterial access. Optimal site management of large bore arterial access is pivotal to reduce the hospital- acquired complications associated with large bore arterial access. We wanted to compare surgical cutdown versus percutaneous closure devices in site management of large bore arterial access. Methods Participants planned for TAVI or EVAR with large bore arterial access more than 10 French were included, while participants with history of bypass surgery, malignancies, thrombophilia, or sepsis were excluded. A consecutive sample of 100 participants (mean age 74.66 ± 2.65 years, 61% males) was selected, underwent TAVI or EVAR with surgical cutdown (group 1) versus TAVI or EVAR with ProglideTM percutaneous closure device (group 2). Results The incidence rate of hematoma was significantly lower in group 2 versus group 1 (p = 0.014), the mean procedure time (minutes) and the median hospital stay (days) were significantly higher in group 1 versus group 2 (t(98) = − 2.631, p = 0.01, and U = 2.403, p = 0.018, respectively), the hemoglobin drop and number of packed red blood cells required for transfusion were significantly higher in group 1 vs group 2 (1.35 ± 0.53 gm/dl vs 1.15 ± 0.29 gm/dl, t(98) = 2.403, P = 0.018 and 0.12 ± 0.33 vs 0.06 ± 0.99, t(98) = 2.975, P = 0.004, respectively), and the c-reactive protein pre- procedure and the c-reactive protein post-procedure were significantly lower in group 2 versus group 1 (U = -2.969, p = 0.003, and U=-2.674, p = 0.007, respectively). Conclusions Our study showed a lower incidence rate of large bore arterial access complications as hematoma, a shorter procedure time, a shorter hospital stay, lower hemoglobin drop, and fewer packed RBCs required for transfusion with percutaneous closure devices compared to surgical cutdown.

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