Transcarotid transcatheter aortic valve replacement: The best alternative?

Abstract

Key Points Approximately 30% of patients referred for transcatheter aortic valve replacement (TAVR) have complex aortic and/or iliofemoral anatomy. In patients with complex vascular anatomy undergoing TAVR, patients undergoing transcarotid (TC) TAVR had lower rates of major vascular complications and no difference in all‐cause death, stroke, major bleeding, access failure, and hospital length of stay compared with transfemoral (TF) TAVR despite worse baseline risk profile. Further adequately powered randomized studies examining the optimal access site in all‐comers undergoing TAVR and the optimal alternative access site in TAVR patients with complex PAD are warranted in this era of contemporary devices to optimize patient outcomes further.