A systematic review of transcatheter aortic valve implantation via carotid artery access

Abstract

& Keywords BackgroundThe carotid artery is a novel access route for transcatheter aortic valve implantation (TAVI). This may represent a viable alternative in patients unsuitable for TAVI via traditional transfemoral access, up to 20%, as well as other access routes such as subclavian, transapical and aortic. This systematic review summarises the current evidence for its safety and feasibility. Methods A systematic review was conducted as per the Preferred Reporting Instructions forSystematic Reviews and Meta-analysis (PRISMA) guidelines using five electronic databases. Results16 studies were identified, including three prospective cohort studies, one retrospective cohort study, three case series and eight case reports. Data on 74 patients (mean age 76.9 years) was extracted including pre-operative work-up, technical procedure details and outcomes.This found 1 intraoperative death, 2 further deaths within 30 days, two incidences of transient ischaemic attack, no incidences of stroke, myocardial infarction, carotid A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT3 access site complications or infection, 1 patient required new dialysis and 1 patient had an intraoperative dissection which resolved. Follow-up from 30 days to 1 year showed symptomatic improvement and echocardiographic improvement in line with those seen in transfemoral TAVI. ConclusionsThe available data on TAVI via carotid access demonstrate technical feasibility with comparable outcomes to other traditional access routes. A low number of patients, heterogeneous clinical endpoints and relatively short follow-up periods limit formal meta-analysis and firmer conclusions. For patients in which other access routes are impossible, TAVI via carotid access represents a viable and potentially crucial alternative in patients who might otherwise be untreatable.

Transcarotid transcatheter aortic valve implantation: A systematic review

“…Gray and bibliography searching was done by reviewing the references of included studies and related review articles. The databases were searched with a combination of the key words: (transcatheter aortic valve replacement OR transcatheter aortic valve implantation OR TAVI OR TAVR) AND (transcarotid OR carotid artery OR transfemoral or transapical), as well as the following 'Medical Subject Headings' (MeSH) search terms derived from our previous review [12]: "TAVI", "TAVR", "PAVR", "aortic valve replacement", "aortic valve implantation", "aortic valve insertion", "aortic heart valve replacement", "aortic heart valve implantation", "aortic heart valve insertion". Last date of the search was 1st August 2017.…”

“…Despite its invasiveness, it has shown favorable outcomes and lower complication rates. However, it is unsuitable for patients with severe respiratory pathology, as well as those with 'porcelain aorta' [12].…”

Alternative Access for Transcatheter Aortic Valve Implantation: Current Evidence and Future Directions

“…However, recent meta-analyses and systematic reviews have suggested that the available data limit formal meta-analysis and, as such, they draw no firm conclusions regarding the safety and efficacy of this method. 31,32…”

Recent developments and controversies in transcatheter aortic valve implantation

“…In those with unfeasible access through one of the above strategies, bail‐out options include transcarotid and caval–aortic approaches. A systematic review on the transcarotid approach has shown comparable outcomes to other access routes, though sample size was small with heterogeneous endpoints . It can be undertaken under local anaesthesia or GA, though there was higher incidence of peri‐operative strokes noted in the latter .…”