Transcatheter aortic valve replacement with a focus on transcarotid: a review of the current literature

Abstract

Valve replacement in high-risk patients with severe aortic stenosis has undergone a huge paradigm shift in the recent years in terms of procedural details and vascular access site for patients who have poor peripheral access. Carotid artery is one of the more promising access sites which has been proven to provide a good alternative site with comparable outcomes to transfemoral approach. In this manuscript, we will provide a review of the current literature on transaortic, transapical, transaxillary and transcarotid approaches to transcatheter aortic valve replacement (TAVR) while focusing on the transcarotid approach.

Update on Transcatheter Aortic Valve Replacement

“…In the majority of cases, the left axillary artery is used, as opposed to the right, because of the more coaxial approach. Outcomes with the transaxillary are similar to those with the transfemoral approach [21].…”

“…There have been multiple vascular access techniques for TAVR implantation [20,21]. There have been no randomized trials comparing different approaches, yet the transfemoral approach has been widely favored based on the available evidence [20,21]. In practice, the chosen approach is determined by the individual patient's anatomy and comorbidities [20,21].…”

“…The transfemoral approach is currently chosen for the majority of TAVR cases [21]. This approach has the most robust data available, which suggests it is superior to alternate approaches [21], and because of its wide use, it is the standard by which other approaches are compared.…”

“…This approach is the only antegrade approach to implantation but requires general anesthesia and surgical cutdown. The transapical approach has also been associated with lower ejection fraction post-procedure, increased rate of blood transfusions, increased risk of bleeding, longer hospital stay, and increased mortality compared with the transfemoral approach [21]. Conversely, data suggest that there are similar rates of stroke, pacemaker implantation, and mortality compared with SAVR [20].…”

“…Conversely, data suggest that there are similar rates of stroke, pacemaker implantation, and mortality compared with SAVR [20]. In the setting of increased reported rates of complications and greater use of hospital resources, the transapical approach is becoming less common in practice and now accounts for \ 5% of all cases performed [20,21]. Direct aortic access requires either partial sternotomy or mini-thoracotomy to achieve direct visualization of the aorta.…”