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Efficacy and Safety of Transcarotid Transcatheter Aortic Valve Replacement: A Systematic Review

Tamunoinemi Bob-Manuel1, Hussein Almusawi2, Tameem Rezan1

  • 1John Ochsner Heart and Vascular Center, New Orleans, LA, USA.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|December 29, 2019
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) via carotid artery (CA) access offers excellent device success and low complication rates for patients unsuitable for traditional TAVR methods. This approach demonstrates favorable outcomes compared to other TAVR access routes.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Surgical Innovation

Background:

  • Transcatheter aortic valve replacement (TAVR) is a critical treatment for aortic stenosis.
  • Traditional TAVR access routes may be unsuitable for patients with severe peripheral vascular disease or high surgical risk.
  • Carotid artery (CA) access is an emerging alternative TAVR approach.

Purpose of the Study:

  • To systematically review and analyze the most up-to-date outcomes of TAVR performed via carotid artery access.
  • To compare the safety and efficacy of carotid access TAVR with other vascular access sites.

Main Methods:

  • A systematic review was conducted following PRISMA guidelines.
  • Comprehensive literature searches were performed in PubMed, SCOPUS, and Embase databases.
  • Statistical analysis was performed using SPSS version 24.

Main Results:

  • Fifteen non-randomized studies involving 2524 TAVR patients were analyzed across five access sites: transcarotid (TC), transfemoral (TF), transapical (TAP), transaortic (TAO), and transaxillary (TAX).
  • Transcarotid TAVR demonstrated high device success (95.6%), with 30-day and 1-year mortality rates of 4.2% and 10.5%, respectively.
  • Compared to transaortic access, transcarotid access showed significantly lower 30-day mortality (2.6% vs. 12.1%). Stroke/TIA rates were 5% at 30 days, with no hemorrhagic strokes. Pacemaker implantation was required in 15.3% of TC cases.

Conclusions:

  • Carotid artery access for TAVR is a viable option with impressive device success and low complication rates, including stroke and pacemaker implantation.
  • Outcomes for transcarotid TAVR are comparable to transapical and transaxillary approaches.
  • Transcarotid TAVR offers a significantly safer alternative regarding 30-day mortality compared to transaortic TAVR.
Abstract

Keywords:
Carotid accessSafetySevere aortic stenosisTAVR

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