Transcarotid Transcatheter Aortic Valve Replacement

Abstract

The transcarotid approach for TAVR is feasible using general or local anesthesia. A higher rate of perioperative strokes was observed with GA.

Alternative access for transcatheter aortic valve replacement in older adults: A collaborative study from France and United States

“…In that study, in-hospital mortality of 14% was ascribed to the selection of high surgical risk patients for the TAo approach, with an estimated mean Society of Thoracic Surgery risk of mortality of 8% [29]. Similar to these findings, the higher death rate associated with TAo approach in our study could be explained by (1) the underlying selection of sicker patients with higher STS score to undergo TAo TAVR, (2) significantly older and more frail patient population with an median age of 84 years, and (3) inability to use traditional femoral approach due to obstructive [24,30] 26 [22,29] 27 [23,31] 27 [23,29] .738…”

Transcarotid approach for TAVI: an optimal alternative to the transfemoral gold standard

“…Our team reported a mortality of 6.3% at 30 days and 16.7% at 1 year. Furthermore, rates of 30-day cerebrovascular events were similar in our registry to existing data with transfemoral TAVI (3), in particular the rate of 30-day stroke was under 2.5% with transcarotid TAVI (2,4,5). Preference for local anesthesia with conscious sedation to general anesthesia is team-dependent; although our team reported possible improvement in neurological outcomes with local anesthesia and conscious sedation, most importantly regarding 30-day strokes with a rate as low as 0% (versus 2.2% in patients treated under general anesthesia) (4).…”

Transcatheter aortic valve replacement: The year in review 2016

“…In multivariate analysis, minimalist TAVR was associated with better 1-year survival. 34 In 174 consecutive transcarotid TAVR procedures using either GA (n = 122) or minimalist strategy (n = 52), 35 30-day death was 7.4%; and 1-year all-cause and cardiovascular mortality were 13% and 8%, respectively. There were no differences in 30-day or 1-year mortality between the GA or minimalist approach patients.…”