Abstract
Objective
Transcarotid access for transcatheter aortic valve replacement is emerging as an alternative
to more traditional nonfemoral access options such as transapical or transaortic;
however, comparative data are limited. The purpose of the study was to analyze outcomes
after transcatheter aortic valve replacement using transcatheter compared with transthoracic
(transapical/transaortic) access.
Methods
The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve
Therapy Registry was queried for patients who underwent transcarotid, transapical,
or transaortic transcatheter aortic valve replacement with the SAPIEN 3 (Edwards Lifesciences,
Irvine, Calif) transcatheter heart valve between June 2015 and July 2019. Thirty-day
unadjusted outcomes were evaluated, and propensity score matching and logistic regression
were used to compare transcatheter access with transthoracic access.
Results
In the propensity-matched analysis, 667 transcarotid transcatheter aortic valve replacement
procedures were compared with 1334 transthoracic procedures. Transcarotid transcatheter
aortic valve replacement was associated with lower mortality (4.2% vs 7.7%, P = .004), less new-onset atrial fibrillation (2.2% vs 12.1%, P < .0001), fewer readmissions at 30 days (9.8% vs 16.1%, P = .0006), shorter median length of stay (3.0 vs 6.0 days, P < .0001), shorter median intensive care unit stay (25 vs 47.2 hours, P < .0001), and greater 30-day Kansas City Cardiomyopathy Questionnaire score improvement
from baseline (25.1 vs 20.8, P = .007). Stroke (4.3% vs 3.7%, P = .44) and major vascular complications (1.4% vs 1.9%, P = .40) were similar.
Conclusions
Transcatheter aortic valve replacement using transcarotid access is associated with
lower 30-day mortality, less atrial fibrillation, shorter intensive care unit and
overall length of stay, fewer readmissions, greater improvement in Kansas City Cardiomyopathy
Questionnaire scores, and no significant difference in stroke or major vascular complications
compared with transthoracic access.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
ICU (intensive care unit), IQR (interquartile range), KCCQ (Kansas City Cardiomyopathy Questionnaire), LOS (length of stay), STS (Society of Thoracic Surgeons), TA (transapical), TAo (transaortic), TAVR (transcatheter aortic valve replacement), TAx (transaxillary), TC (transcarotid), THV (transcatheter heart valve), TVT (Transcatheter Valve Therapy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 20, 2020
Accepted:
September 28,
2020
Received in revised form:
September 17,
2020
Received:
April 8,
2020
Footnotes
Edwards Lifesciences performed the statistical analysis. The views or opinions presented are solely those of authors and do not represent those of the American College of Cardiology, Society of Thoracic Surgeons, or Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
Identification
Copyright
© 2020 by The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- What do we know about the indications for a transcarotid approach?The Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 2
- PreviewI read with great interest a recent article in which the authors compared the 30-day outcomes between patients who underwent transcarotid (TC) transcatheter aortic valve replacement (TAVR) with those who underwent transthoracic TAVR using the Sapien 3 valve (S3) (Edwards Lifesciences, Irvine, Calif).1
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- PreviewAllen and colleagues1 explored the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry to assess outcomes of patients undergoing Sapien 3 (Edwards Lifesciences, Irvine, Calif) transcatheter aortic valve replacement (TAVR) via either transcarotid (TC) or transthoracic (ie, transaortic or transapical) approach. The authors performed a propensity score-matched analysis and found that patients who underwent TC TAVR had shorter hospital length of stay, lower rates of postoperative morbidity, and lower mortality compared with transthoracic approaches; the analysis accounted for year of procedure in an attempt to address the influence of era.
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