Surgical versus percutaneous femoral access for delivery of large-bore cardiovascular devices (from the PARTNER Trial)

James M. McCabe, Pei Hsiu Huang, David J. Cohen, Eugene H. Blackstone, Frederick G.P. Welt, Michael J. Davidson, Tsuyoshi Kaneko, Marvin H. Eng, Keith B. Allen, Ke Xu, Ashley M. Lowry, Yang Lei, Jeevanantham Rajeswaran, David L. Brown, Michael J. Mack, John G. Webb, Craig R. Smith, Martin B. Leon, Andrew C. Eisenhauer

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16 Scopus citations


It is unclear if surgical exposure confers a risk advantage compared with a percutaneous approach for patients undergoing endovascular procedures requiring large-bore femoral artery access. From the randomized controlled Placement of Aortic Transcatheter Valve trials A and B and the continued access registries, a total of 1,416 patients received transfemoral transcatheter aortic valve replacement, of which 857 underwent surgical, and 559 underwent percutaneous access. Thirty-day rates of major vascular complications and quality of life scores were assessed. Propensity matching was used to adjust for unmeasured confounders. Overall, there were 116 major vascular complications (8.2%). Complication rates decreased dramatically during the study period. In unadjusted analysis, major vascular complications were significantly less common in the percutaneous access group (35 [6.3%] vs 81 [9.5%] p = 0.032). However, among 292 propensity-matched pairs, there was no difference in major vascular complications (22 [7.5%] vs 28 [9.6%], p = 0.37). Percutaneous access was associated with fewer total in-hospital vascular complications (46 [16%] vs 66 [23%], p = 0.036), shorter median procedural duration (97 interquartile range [IQR 68 to 166] vs 121 [IQR 78 to 194] minutes, p <0.0001), and median length of stay (4 [IQR 2 to 8] vs 6 [IQR 3 to 10] days, p <0.0001). There were no significant differences in quality of life scores at 30 days. Surgical access for large-bore femoral access does not appear to confer any advantages over percutaneous access and may be associated with more minor vascular complications.

Original languageEnglish
Pages (from-to)1643-1650
Number of pages8
JournalAmerican Journal of Cardiology
Issue number10
StatePublished - May 15 2016


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