Transcatheter Aortic Valve Replacement: Comparing Transfemoral, Transcarotid, and Transcaval Access

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Transcatheter aortic valve replacement (TAVR) often requires non-femoral access in 10-20% of patients.
• Transcarotid (TC) and transcaval (TCav) approaches are alternatives to transfemoral (TF) access, avoiding transthoracic procedures.

Purpose of the Study:

• To compare outcomes of TF, TC, and TCav approaches in TAVR.
• To evaluate the safety and efficacy of alternative TAVR access routes.

Main Methods:

• Retrospective analysis of 463 TAVR patients (January 2015 - March 2017).
• Valve delivery via TF (n=373), TCav (n=58), or TC (n=32).
• Comparison of patient demographics, procedural outcomes, and 1-year survival.

Main Results:

• TCav patients had higher STS risk scores; TC and TCav patients had more comorbidities.
• Median length of stay was longer for TCav (4 days) vs TF (2 days).
• Procedural mortality, discharge home rates, 30-day readmissions, and 1-year survival were similar across all groups.

Conclusions:

• Non-femoral TC and TCav TAVR access yield similar 30-day/in-hospital and 1-year survival to TF access.
• These alternative TAVR methods offer equivalent procedural and intermediate-term outcomes without surgical chest entry.