Transfemoral versus transcarotid access for transcatheter aortic valve replacement

• Published in: JTCVS techniques Vol. 15; pp. 46 - 53
• Main Authors: Olivier, Maud-Emmanuelle, Di Cesare, Alessandro, Poncet, Anne, Brasselet, Camille, Metz, Damien, Biancari, Fausto, Ruggieri, Vito Giovanni, Faroux, Laurent, Muccio, Salvatore, Torossian, Pierre-Frédéric, Duval, Sébastien, Liu, Li, Durand, Emmanuelle, Tassan, Sophie, Heroguelle, Virginie
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-10-2022; Elsevier
• Subjects: Adult: Aortic Valve; aortic stenosis; carotid artery; TAVI; TAVR; transcatheter aortic valve replacement; TF; aortic stenosis; EuroSCORE II; TAVI; transcatheter aortic valve replacement; Fr; carotid artery; TAVR; TC
• ISSN: 2666-2507; 2666-2507
• DOI: 10.1016/j.xjtc.2022.05.019

To compare the outcomes after transcatheter aortic valve replacement (TAVR) through a transfemoral (TF) and transcarotid (TC) access at our institution.
From January 2014 to January 2020, 62 TC-TAVR and 449 TF-TAVR were performed using 2 prosthesis devices (Edwards SAPIEN 3, n = 369; Medtronic Evolut R, n = 142). Propensity score matching was used to adjust for imbalance in the baseline characteristics of the study groups.
Propensity score matching provided 62 matched pairs with comparable operative risk (mean European System for Cardiac Operative Risk Evaluation II, TC-TAVR 7.6% vs TF-TAVR 6.6%, P = .17). Thirty-day mortality (4.8% vs 3.2%, P = 1.00) and 2-year mortality (11.3% vs 12.9%, P = .64) after TC-TAVR were comparable with TF-TAVR. Strokes were numerically more frequent after TC-TAVR compared with TF-TAVR (3.2% vs 0%, P = .23), but the difference did not reach statistical significance. TF-TAVR was associated with a significantly greater risk of permanent pacemaker implantation (29.0% vs 12.9%, P = .04) compared with TC-TAVR. Other complications were not frequent and were similarly distributed between the matched groups.
TC access for TAVR was associated with satisfactory results compared to the femoral access. TC-TAVR could be considered a valid and safe alternative to TF-TAVR when femoral access is contraindicated.