Transcarotid transcatheter aortic valve implantation: multicentre experience in France

Folliguet, Thierry; Nicolas, Laurent; Bertram, Maxime; Zannis, Konstantinos; Elfarra, Mazen; Vanhuyse, Fabrice; Maureira, Pablo; Modine, Thomas

doi:10.1093/ejcts/ezx264

Cited by 34 publications

(34 citation statements)

References 21 publications

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“…Patients in need of an alternative to TF access were of higher surgical risk, but their 2-year mortality was similar to those treated through femoral access. Interestingly, this registry showed an increased risk of stroke (OR 2.42) and bleeding (OR 2.0) compared to TF, but not of vascular complications [9,10].…”

Section: Discussionmentioning

confidence: 75%

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: Discussionmentioning

confidence: 75%

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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“…Figure 1 shows the PRISMA flow diagram of study selection. There were a total of 17 retrospective studies included in our analysis with a total of 2082 patients 6‐22 . The median follow‐up was 1 (1–1) month.…”

Section: Resultsmentioning

confidence: 99%

Carotid access for transcatheter aortic valve replacement: A meta‐analysis

Sharma

Chaudhary

Ghuneim

et al. 2020

Cathet Cardio Intervent

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Objective We sought to evaluate the feasibility and safety of carotid access transcatheter aortic valve replacement (TAVR) by performing a meta‐analysis of published cases. Background Several case series and regional data have provided initial basis for carotid access TAVR in patients with prohibitive femoral approach. We performed this meta‐analysis to provide further evidence of feasibility and safety of carotid TAVR. Methods We searched PubMed, EMBASE, CINAHL, and Cochrane CENTRAL for any study on carotid access TAVR involving ⩾5 patients since inception till March 1, 2020. Random‐effects model was used to compute overall effects. The outcomes analyzed were all‐cause mortality, Transient ischemic attack (TIA)/stroke, need for permanent pacemaker (PPM) implantation, pericardial tamponade, access site complications, major bleeding, and length of stay. Results There was a total of 17 retrospective studies (n = 2082) with a median follow‐up of 1 month. Mean age of the patient was 80 years. Mean Euroscore and STS scores were 15 ± 6.2 and 7.9 ± 3.3, respectively. The procedural success rate was 99%. The rate of all‐cause mortality was 6.7% (range 4.6–9.7%, p < .001, I2 = 67%). Incidence of TIA/stroke was 3.9% (range 3.1–4.8%, p < .001, I2 = 0%) and PPM implantation was 16.7% (range 12.5–21.9%, p < .001, I2 = 56%). Rate of pericardial tamponade, vascular complication, and major bleeding were 1.7, 2.5, and 7%, respectively. Average length of hospital stay was 7.7 days. Conclusion Our results show that transcarotid approach is a feasible option in patients with prohibitive femoral access for TAVR.

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“…While results are acceptable, they still report a 5.7% incidence of cerebral vascular events and a 30‐day mortality of 7% after TC TAVR. More recently, Folliguet et al reported a series of 145 TC patients over 2 years at 3 centers. They also report a 5.5% incidence of TIA/stroke, 1 episode of a carotid dissection, a 30‐day mortality of 6.25%, and a 22.2% incidence of PPM.…”

Section: Discussionmentioning

confidence: 99%

Contemporary suprasternal transcatheter aortic valve replacement: A multicenter experience using a simple, reliable alternative access approach

Eudailey

Olds

Lewis

et al. 2019

Cathet Cardio Intervent

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Objectives To describe outcomes after suprasternal (SS) transcatheter aortic valve replacement (TAVR) as a new alternative access approach. Background There still remains a cohort of the TAVR population who are not suitable for a transfemoral (TF) approach. SS‐TAVR is a safe and effective alternative to TF‐TAVR and has now become our preferred alternative access route. Methods We retrospectively reviewed all patients from New York Presbyterian Hospital, Columbia University Medical Center and Princeton Baptist Medical Center who underwent SS‐TAVR from 2015 to July 2018. A total of 84 patients were included in the study. Results Technical success was achieved in all cases. Thirty‐day survival was 98.8% (n = 83). There were minimal complications. Most notably, there were no transient ischemic attacks or strokes (0%, n = 0). Reexploration for bleeding was 3.6% (n = 3), and major bleeding was 1.7% (n = 1). We also achieved satisfactory results with a mean aortic valve gradient of 6.07 ± 3.79 mmHg and an aortic valve area of 2.21 ± 0.51 cm2. No patients had anything more than mild paravalvular leak. The mean length of stay (LOS) in the intensive care unit was 1.42 ± 1.23 days, and hospital LOS was 4.20 ± 3.29 days. Conclusions SS access for TAVR is an extremely important technique to have in any valve team's alternative access armamentarium. This technique can be safely and reliably reproduced with any standard hybrid operating room setup and no additional equipment, and it can be used with any commercially available valve system. In the current experience, minimal complications and excellent early term results were obtained.

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Transcarotid transcatheter aortic valve implantation: multicentre experience in France

Abstract: Transcarotid aortic valve implantation is a safe alternative to transfemoral transcatheter aortic valve implantation, with direct access to the aortic valve, which can be performed with limited incision.

Cited by 34 publications

References 21 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

Carotid access for transcatheter aortic valve replacement: A meta‐analysis

Contemporary suprasternal transcatheter aortic valve replacement: A multicenter experience using a simple, reliable alternative access approach

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