Haydarpasa Numune Med J. 2025; 65(1): 50-55 | DOI: 10.14744/hnhj.2024.45578

Comparison of Standard Incision and Deep Incision Approaches in Terms of Bleeding and Vascular Complications in Patients Undergoing Percutaneous Transcatheter Aortic Valve Implantation

Osman Uzman¹, Koray Demir², Duygu Ýnan³, Ayça Gümüþdað², Koray Kalenderoðlu², Evliya Akdeniz⁴, Mehmet Saygý⁵, Ýlhan Ýlker Avcý², Gönül Zeren², Can Yücel Karabay^1
1Department of Cardiology, University of Health Sciences Türkiye, Dr. Siyami Ersek Research and Training Hospital, Istanbul, Türkiye
²Department of Cardiology, Dr. Siyami Ersek Research and Training Hospital, Istanbul, Türkiye
³Department of Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye
⁴Department of Cardiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
⁵Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, Türkiye

INTRODUCTION: In this study, we aimed to compare bleeding and vascular complications associated with deep incision (with removal of perivascular adipose tissue) and standard incision (without removal of perivascular adipose tissue) approaches in patients who underwent transcatheter aortic valve implantation (TAVI).
METHODS: We retrospectively included 80 adult patients who underwent elective percutaneous TAVI at a tertiary cardiac center between 2012 and 2018. The percutaneous TAVI procedure was performed in 41 patients using the deep incision approach and in 39 patients using the standard incision approach. The primary outcome was bleeding and vascular complications.
RESULTS: The percutaneous TAVI procedure was performed in 41 patients using the deep incision approach and in 39 patients using the standard incision approach. In the deep incision and standard incision groups, respectively, the number of female patients was 27 (65.9%) and 21 (53.8%), while the mean age was 80.46±6.43 years and 78.79±7.87 years. Bleeding, according to the VARC-2 (The Valve Academic Research Consortium-2 Consensus Document) criteria, was lower in the deep incision group but did not reach statistical significance: 17 (41.5%) in the deep incision group vs. 19 (50%) in the standard incision group (p=0.447). Mean hemoglobin decline (g/dL) was significantly lower in the deep incision group (0.55±1.44) compared to the standard incision group (1.93±1.98) (p=0.001). The results for in-hospital mortality, hematoma, pseudoaneurysm, femoral artery dissection, and stenosis were similar between the two groups.
DISCUSSION AND CONCLUSION: In patients undergoing percutaneous TAVI, the mean hemoglobin decline was found to be lower in those who underwent the deep incision approach compared to the standard incision approach. No significant difference was found between the two methods in terms of vascular complications and other bleeding complications.

Keywords: Aortic valve stenosis, bleeding, transcatheter aortic valve implantation, transcatheter aortic valve replacement, vascular complication.

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