{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T14:43:36Z","timestamp":1774968216808,"version":"3.50.1"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background\u2003Third-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.<\/jats:p><jats:p>Methods\u2003All 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.<\/jats:p><jats:p>Results\u2003A 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\u2009\u00b1\u20097.5 vs. 83.8\u2009\u00b1\u20097.5 years, p\u2009&lt;\u20090.001), had smaller femoral arteries (8.0\u2009\u00b1\u20091.6 vs. 7.6\u2009\u00b1\u20091.6\u2009mm, p\u2009=\u20090.034) and more severe vessel calcifications (17.5 vs. 1.0%, p\u2009&lt;\u20090.001). Procedure time was similar for cutdown and percutaneous access (64.0 vs. 64.5\u2009minutes, p\u2009=\u20090.879). With percutaneous access, 80 major vascular complications (10%) occurred, whereas with surgical cutdown, no major vascular complications occurred (p\u2009&lt;\u20090.005). No wound infection occurred after surgical cutdown. The mean length of stay was 8 days in both groups.<\/jats:p><jats:p>Conclusion\u2003Surgical cutdown for vascular access avoids vascular complications in patients with small or severely calcified femoral arteries.<\/jats:p>","DOI":"10.1055\/s-0041-1725202","type":"journal-article","created":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T23:38:04Z","timestamp":1616629084000},"page":"199-204","source":"Crossref","is-referenced-by-count":5,"title":["Surgical Cutdown Avoids Vascular Complications in Transcatheter Aortic Valve Replacement in Calcified and Small Femoral Arteries"],"prefix":"10.1055","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8540-7090","authenticated-orcid":false,"given":"Melchior","family":"Burri","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hendrik","family":"Ruge","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7560-9257","authenticated-orcid":false,"given":"Magdalena","family":"Erlebach","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R\u00fcdiger","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany"},{"name":"Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich at the Technical University of Munich, Munich, Germany"},{"name":"DZHK (German Center for Cardiovascular Research)-partner Site Munich Heart Alliance, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,3,24]]},"reference":[{"issue":"S 30","key":"ref1","doi-asserted-by":"crossref","first-page":"S3595","DOI":"10.21037\/jtd.2018.09.48","article-title":"Percutaneous or surgical access for transfemoral transcatheter aortic valve implantation","volume":"10","author":"A N Vora","year":"2018","journal-title":"J Thorac Dis"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1055\/s-0038-1676131","article-title":"German Heart Surgery Report 2017: the annual updated registry of the German Society for Thoracic and Cardiovascular Surgery","volume":"66","author":"A Beckmann","year":"2018","journal-title":"Thorac Cardiovasc 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Kappetein","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"08","key":"ref6","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.amjcard.2016.07.045","article-title":"Frequency and effect of access-related vascular injury and subsequent vascular intervention after transcatheter aortic valve replacement","volume":"118","author":"D Dencker","year":"2016","journal-title":"Am J Cardiol"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.29095","article-title":"Access site related vascular complications with third generation transcatheter heart valve systems","author":"H Ruge","year":"2020","journal-title":"Catheter Cardiovasc Interv"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1093\/icvts\/ivy114","article-title":"Surgical cut down for vascular access with conscious sedation for transcatheter aortic valve replacement: the best of both worlds?","volume":"27","author":"A Cardounel","year":"2018","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"690","DOI":"10.4244\/EIJV11I6A137","article-title":"Comparison of suture-based vascular closure devices in transfemoral transcatheter aortic valve implantation","volume":"11","author":"M Barbanti","year":"2015","journal-title":"EuroIntervention"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1002\/ccd.28295","article-title":"Impact of percutaneous closure device type on vascular and bleeding complications after TAVR: A post hoc analysis from the BRAVO-3 randomized trial","volume":"93","author":"D Power","year":"2019","journal-title":"Catheter Cardiovasc Interv"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"262","DOI":"10.4244\/EIJ-D-19-00523","article-title":"Clinical experience with a novel large bore vascular closure device after transfemoral transcatheter aortic valve replacement","volume":"16","author":"H Ruge","year":"2020","journal-title":"EuroIntervention"},{"issue":"07","key":"ref12","doi-asserted-by":"crossref","first-page":"e007258","DOI":"10.1161\/CIRCINTERVENTIONS.119.007258","article-title":"Pivotal clinical study to evaluate the safety and effectiveness of the MANTA percutaneous vascular closure device","volume":"12","author":"D A Wood","year":"2019","journal-title":"Circ Cardiovasc Interv"}],"container-title":["The Thoracic and Cardiovascular 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