Carotid versus femoral access for transcatheter aortic valve replacement: comparable results in the current era

Abstract

OBJECTIVES The carotid approach for transcatheter aortic valve replacement (TAVR) has been shown to be feasible and safe. The goal of this study was to compare the 30-day outcomes of trans-carotid (TC) and transfemoral (TF) TAVR. METHODS This retrospective study enrolled 500 consecutive patients treated by TC-TAVR (n = 100) or TF-TAVR (n = 400) with percutaneous closure between January 2018 and January 2020 at the Nantes University Hospital. The primary end-point was the occurrence of cardiovascular death and cerebrovascular events at 30 days. RESULTS The mean age was 79.9 ± 8.1 in the TC group and 81.3 ± 6.9 (P = 0.069) in the TF group. The TC group had more men (69% vs 50.5%; P = 0.001) and more patients with peripheral vascular disease (86% vs 14.8%; P < 0.0001). Cardiac characteristics were similar between the groups, and the EuroSCORE II was 3.8 ± 2.6% vs 4.6 ± 6.0%, respectively (P = 0.443). The 30-day mortality was 2% in the TC group versus 1% in the TF group (P = 0.345). TC-TAVR was not associated with an increased risk of stroke (2% vs 2.5%; P = 0.999) or major vascular complications (2% vs 4%; P = 0.548). More permanent pacemakers were implanted in the TF group (14.9% vs 5.6%; P = 0.015), and no moderate or severe aortic regurgitation was observed in the TC group (0 vs 3.3%; P = 0.08). TC-TAVR was not associated with an increased risk of mortality or stroke at 30 days (odds ratio 1.32; 95% confidence interval 0.42–4.21; P = 0.63) in the multivariable analysis. CONCLUSIONS No statistically significant differences between TC-TAVR and TF-TAVR were observed; therefore, TC-TAVR should be the first alternative in patients with anatomical contraindications to the femoral route.

Transapical‐transcatheter aortic valve implantation in patients without transvascular options: Modified transapical approach

“…One of the most recent themes in the TAVI world is the alternative, nontransfemoral approach (TS/Tax and TC). Some recent studies have proposed any “first alternative approach” when TF‐TAVI is contraindicated 2–5 . As seen in this study, patients who cannot undergo TF‐TAVI are candidates with complex vessel characteristics, and a single vascular alternative approach will be insufficient to serve those patients.…”

“…Some recent studies have proposed any "first alternative approach" when TF-TAVI is contraindicated. [2][3][4][5] As seen in this study, patients who cannot undergo TF-TAVI are candidates with complex vessel characteristics, and a single vascular alternative approach will be insufficient to serve those patients. As it is known that 10%-15% of TAVI candidates cannot undergo the TF approach, 1 an incidence of 5% of the TAVI population who cannot undergo transvascular approaches, derived from the current study, is to be considered in the heart teams.…”

“…1 In contemporary circumstances, alternative transvascular approaches, such as transcarotid (TC) and transsubclavian/transaxillary (TS/Tax), have been studied and preferred for this specific TAVI population. [2][3][4][5] However, it is to postulate that patients who express severe iliofemoral artery disease/calcification grade may exhibit general, iliofemoral-remote artery diseases/calcifications. This may preclude the use of the TF approach and other transvascular approaches, in which a nonvascular TAVI approach is needed.…”

ACURATE neo™ aortic valve implantation via carotid artery access: first case report

“…In patients ineligible for transcatheter aortic valve replacement (TAVR) via the traditional femoral access route due to severe peripheral vascular disease, carotid artery access is a suitable alternative thoracic access route [1,2]. While Self-expanding CoreValve® (Medtronic, Minneapolis, MN, USA) were the first transcatheter heart valves (THV) to be implanted via this non-femoral access [2] Here, we report the first implantation of an ACURATE neo™ aortic valve system via the right common carotid artery access (RCCA).…”

ACURATE neo™ Aortic Valve implantation via carotid artery access: First case report

“…In patients ineligible for transcatheter aortic valve replacement (TAVR) via the traditional femoral access route due to severe peripheral vascular disease, carotid artery access is a suitable alternative thoracic access route 1,2 . Self-expanding valves are the rst to be implanted via this non-femoral access 2 .…”