Comparison of the short-term safety and efficacy of transcarotid and transfemoral access routes for transcatheter aortic valve implantation

Hudziak, Damian; Wojakowski, Wojciech; Malinowski, Marcin; Gocoł, Radosław; Żak, Aleksandra; Morkisz, Łukasz; Ochała, Andrzej; Parma, Radosław; Smołka, Grzegorz; Ciosek, Joanna; Nowak, A; Lelek, Michał; Deja, Marek

doi:10.33963/kp.15697

Cited by 11 publications

(17 citation statements)

References 28 publications

(44 reference statements)

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“…Our previously published data suggest that transcarotid access is comparable in outcomes to TF in properly selected patients and can be safely used as the first-choice alternative access in patients in whom the TF approach is not feasible [3]. In our experience, it is also safe to use local anesthesia as suggested in previously published studies [11].…”

Section: Discussionsupporting

confidence: 69%

“…The current paper provides long term outcomes with routine follow-up with carotid duplex ultrasound (DUS) of all patients treated with TC-TAVI in a large academic institution where TC is the preferred alternative access when TF is not feasible. This is a long-term extension of our previously published data with systematic follow-up with carotid ultrasound [1][2][3].…”

Section: Introductionmentioning

confidence: 54%

“…The methods and design of the registry were previously published [2,3]. In this prospective study, we enrolled consecutive patients with severe symptomatic aortic stenosis who were treated in our hospital with TC-TAVI between 2017 and 2019.…”

Section: Methodsmentioning

confidence: 99%

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Long-Term Clinical Outcomes and Carotid Ultrasound Follow-Up of Transcarotid TAVI. Prospective Single-Center Registry

Hudziak

Hajder

Gocoł

et al. 2021

JCM

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This study aimed to prospectively evaluate the safety and long-term clinical outcomes of cerebral-oximetry-guided transcarotid transcatheter aortic valve implantation (TC-TAVI) with systematic follow-up with carotid ultrasound. Thirty-three TCTAVI procedures were performed in our center from 2017 to 2019. Our analysis includes in-hospital outcomes and long-term follow-up data on mortality, echocardiographic parameters, carotid Doppler ultrasound, and VARC-2 defined clinical events. Intraoperatively, one patient died, and one had a transient ischemic attack (TIA). The following events occurred in-hospital postoperatively: myocardial infarction (3.0%), cardiac tamponade (3.0%), new-onset atrial fibrillation (6.3%), need for temporary pacing (27.3%) and need for pacemaker implantation (15%). The mean follow-up was 19.5 ± 9.52 months. In the long-term follow-up, the two-year survival rate was 83% ± 14. The echocardiographic parameters did not differ significantly from the postprocedural values, and the ultrasound did not show any cases of significant vessel narrowing. The mean peak systolic velocity (PSV) was 71.6 cm/s in the left common carotid artery and 70.6 cm/s in the right common carotid artery. In conclusion, cerebral oximetry-guided TC access is safe, has a favorable long-term outcome, and does not increase the risk of plaque formation in the carotid artery. In a carefully selected group of patients, it might be considered as a first-choice alternative to TF access.

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 54%

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Long-Term Clinical Outcomes and Carotid Ultrasound Follow-Up of Transcarotid TAVI. Prospective Single-Center Registry

Hudziak

Hajder

Gocoł

et al. 2021

JCM

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“…All SE THVs belonged to the Medtronic CoreValve family (Medtronic, Minneapolis, MN, USA). Almost all remaining cases benefited from the Edwards SAPIEN family THVs (Edwards Lifesciences, Irvine, CA, USA), except one, reported by Hudziak et al, in which an Abbott Portico THV (Abbott Vascular, Santa Clara, CA, USA) was implanted ( 24 ). 70.8% of interventions were performed via the left common carotid artery (CCA).…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies reported the incidence of PPM implantation ( 11 , 20 , 22 – 24 , 26 , 27 ). There was no significant difference between TC-TAVR and TF-TAVR, either when all 7 studies were included (RR, 1.01, 95% CI, 0.87–1.17, I 2 = 0%, p = 0.94), or in the subgroup of propensity-score matched studies (only data from one study were available, RR, 1.06, 95% CI, 0.88–1.27, p = 0.54; Figures 5A,B ).…”

Section: Resultsmentioning

confidence: 99%

Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Monney

Hullin

et al. 2021

Front. Cardiovasc. Med.

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Background: The transfemoral (TF) route is the gold-standard access for transcatheter aortic valve replacement (TAVR). In 10–15% of patients, alternative accesses are needed, such as the transcarotid (TC) access. We performed a meta-analysis to compare 30-day mortality and complications between TC-TAVR and TF-TAVR.Methods: We searched PubMed/MEDLINE and EMBASE from inception to January 2021 to identify articles comparing TC-TAVR and TF-TAVR. Patients' baseline characteristics, procedural outcomes, and clinical 30-day outcomes were extracted.Results: We identified 9 studies, among which 2 used propensity-score matching, including 1,374 TC patients and 3,706 TF patients. TC-TAVR was associated with significantly higher EuroSCORE II and Logistic EuroSCORE values (respectively 8.0 ± 6.7 vs. 6.3 ± 5.4, p = 0.002 and 20.8 ± 14.2% vs. 20.0 ± 13.4%, p = 0.04), a higher prevalence of peripheral artery disease (52.6 vs. 32.8%, p = 0.001), previous cardiac surgery (26.3 vs. 22.4%, p = 0.008) and coronary artery disease (64.6 vs. 60.5%, p = 0.020). The pooled results found TC-TAVR to be associated with a significantly higher 30-day mortality risk (RR, 1.41, 95% CI, 1.02–1.96, p = 0.040), and a lower rate of 30-day major vascular complications (RR, 0.48, 95% CI, 0.25–0.92, p = 0.030). No significant difference was found regarding permanent pacemaker implantation, major bleeding and acute kidney injury. A subgroup analysis of the two propensity-score matched studies found a statistically increased risk of 30-day neurovascular complications (RR, 1.61, 95% CI, 1.02–2.55, p = 0.040).Conclusion: Compared with TF-TAVR, TC-TAVR was associated with an increased risk of 30-day mortality, likely related to a higher surgical risk and comorbidity burden, and with an increased risk of 30-day neurovascular complications. Careful preprocedural patient selection and close periprocedural neurological monitoring are paramount.

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Network Meta-Analysis Comparing the Short- and Long-Term Outcomes of Alternative Access for Transcatheter Aortic Valve Replacement

Ranka¹,

Lahan²,

Chhatriwalla³

et al. 2022

Cardiovascular Revascularization Medicine

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Comparison of the short-term safety and efficacy of transcarotid and transfemoral access routes for transcatheter aortic valve implantation

Cited by 11 publications

References 28 publications

Long-Term Clinical Outcomes and Carotid Ultrasound Follow-Up of Transcarotid TAVI. Prospective Single-Center Registry

Long-Term Clinical Outcomes and Carotid Ultrasound Follow-Up of Transcarotid TAVI. Prospective Single-Center Registry

Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Network Meta-Analysis Comparing the Short- and Long-Term Outcomes of Alternative Access for Transcatheter Aortic Valve Replacement

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