Short term Outcomes of Transcarotid vs Transaxillary Artery TAVR Procedures: A Single Center Experience

Abstract

Objective: Patients with prohibitive iliofemoral disease undergoing transcatheter aortic valve replacement (TAVR) often require alternative, nonfemoral access for valve delivery and implantation. To date, there is a paucity of data directly comparing the transcarotid and trans-subclavian access routes. We thus sought to evaluate the short-term outcomes of both approaches. Methods: All TAVR procedures performed via a transcarotid or trans-subclavian approach between June 2015 and May 2019 were included. Data were retrospectively collected from The Society of Thoracic Surgeons/American College of Cardiology (STS/ACC) Transcatheter Valve Therapy (TVT) Registry. Outcomes are reported in accordance with the Valve Academic Research Consortium definitions. Results: A total of 131 patients were treated with either transcarotid or trans-subclavian TAVR during the study period (transcarotid=57 vs. trans-subclavian=74). Transcarotid patients had higher Society of Thoracic Surgeons risk scores (14.87±7.58 vs. 11.42±7.52; p=0.018) and prevalence of hypertension (100% vs. 89%; p=0.010). Trans-subclavian patients had higher rates of prior coronary interventions (43% vs. 26%; p=0.045). The transcarotid approach exhibited shorter fluoroscopy time (minutes, 22.55±8.12 vs. 33.62±13.94; p<0.001) and lower contrast volume (milliliter, 92.95±46.15 vs. 113.28±55.00; p=0.026). ICU stay and overall hospital stay were shorter with the transcarotid approach, (hours, 24.9 vs. 72.7; p=0.03) and (days, 5.86±5.56 vs. 8.95±8.23; p=0.016). There were no differences between the groups with respect to 30-day mortality (0% vs. 5.4%; p=0.132), stroke (7% vs. 8%; p=0.816), need for permanent pace-maker or vascular complication. Conclusions: The transcarotid approach yields lesser fluoroscopy time, contrast volume, ICU and overall hospital stay compared to the trans-subclavian approach. Short-term mortality and stroke rates are similar between the two approaches. KEYWORD: e-P-22 The authors do not declare any conflict of interest.