Transcarotid Versus Transapical and Transaortic Access for Transcatheter Aortic Valve Replacement

Abstract

Transcatheter aortic valve replacement (TAVR) using transcarotid access may improve outcomes compared with transapical or transaortic access. This study retrospectively evaluated 165 patients who were undergoing alternate access TAVR using transcarotid (n= 84), transapical (n= 48), and transaortic (n= 33) access. The 30-day outcomes and 2-year Kaplan-Meier survival were analyzed using a multivariable Cox proportional hazards model. The median Society of Thoracic Surgeons predicted risk of mortality was similar among patients treated by transcarotid, transapical, and transaortic access (9.0% [interquartile range (IQR), 6.6, 12.0] vs 9.1% [IQR, 7.0, 11.7] vs 10.0% [IQR, 8.5, 13.0]; p= 0.14), respectively. Patients treated with transcarotid TAVR had a trend toward lower 30-day mortality (3.6% [3 of 84] vs 6.3% [3 of 48] vs 15.2% [5 of 33]; p= 0.09) and significantly better 2-year survival (88.4% vs 79.2% vs 63.6%; p= 0.004) compared with patients treated by transapical and transaortic access, respectively. In addition, transcarotid access was associated with a shorter median length of stay (3.0 days [IQR, 2.0, 5.0] vs 6.5 days [IQR. 5.0, 9.5] vs 7.0 days [IQR, 5.0, 9.0]; p < 0.001), lower transfusion rate (4.8% [4 of 84] vs 12.0% [12 of 48] vs 24.2% [8 of 33]; p < 0.001), higher likelihood of discharge to home without home health care (89.3% [75 of 84] vs 54.2% [26 of 48] vs 42.4% [14 of 33]; p < 0.001), and similar 30-day stroke rates (2.4% [2 of 84] vs 2.1% [1 of 48] vs 3.0% [1 of 33];p= 0.9). Transcarotid compared with transapical and transaortic access for TAVR is associated with shorter length of stay, fewer transfusions, more frequent discharge to home, and better 2-year survival.