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. 2022 Jul 20:15:46-53.
doi: 10.1016/j.xjtc.2022.05.019. eCollection 2022 Oct.

Transfemoral versus transcarotid access for transcatheter aortic valve replacement

Maud-Emmanuelle Olivier  1   2 , Alessandro Di Cesare  1   2 , Anne Poncet  1   2 , Camille Brasselet  3 , Damien Metz  2   4 , Fausto Biancari  5   6   7 , Vito Giovanni Ruggieri  1   2 ; Reims Heart Team Group
Collaborators, Affiliations

Transfemoral versus transcarotid access for transcatheter aortic valve replacement

Maud-Emmanuelle Olivier et al. JTCVS Tech. .

Abstract

Objectives: To compare the outcomes after transcatheter aortic valve replacement (TAVR) through a transfemoral (TF) and transcarotid (TC) access at our institution.

Methods: From January 2014 to January 2020, 62 TC-TAVR and 449 TF-TAVR were performed using 2 prosthesis devices (Edwards SAPIEN 3, n = 369; Medtronic Evolut R, n = 142). Propensity score matching was used to adjust for imbalance in the baseline characteristics of the study groups.

Results: Propensity score matching provided 62 matched pairs with comparable operative risk (mean European System for Cardiac Operative Risk Evaluation II, TC-TAVR 7.6% vs TF-TAVR 6.6%, P = .17). Thirty-day mortality (4.8% vs 3.2%, P = 1.00) and 2-year mortality (11.3% vs 12.9%, P = .64) after TC-TAVR were comparable with TF-TAVR. Strokes were numerically more frequent after TC-TAVR compared with TF-TAVR (3.2% vs 0%, P = .23), but the difference did not reach statistical significance. TF-TAVR was associated with a significantly greater risk of permanent pacemaker implantation (29.0% vs 12.9%, P = .04) compared with TC-TAVR. Other complications were not frequent and were similarly distributed between the matched groups.

Conclusions: TC access for TAVR was associated with satisfactory results compared to the femoral access. TC-TAVR could be considered a valid and safe alternative to TF-TAVR when femoral access is contraindicated.

Keywords: EuroSCORE II, European System for Cardiac Operative Risk Evaluation II; Fr, French; TAVI; TAVR; TAVR, transcatheter aortic valve replacement; TC, transcarotid; TF, transfemoral; aortic stenosis; carotid artery; transcatheter aortic valve replacement.

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Figures

None
Survival of the propensity score matched groups.
Figure 1
Figure 1
Survival of the propensity score–matched groups. Curves illustrate the survival rate in each group. It was more significant for the TF-TAVI group during the first year, but after 1 year, the survival was more significant in the TC-TAVI group and was stabilized at 2 years. All patients were informed and gave their written consent for publication of the study data. TF, Transfemoral; TC, transcarotid; TAVR, transcatheter aortic valve replacement.
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