Carotid access for transcatheter aortic valve replacement: A meta-analysis

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Surgical Innovation

Background:

• Transcatheter aortic valve replacement (TAVR) is a standard treatment for severe aortic stenosis.
• The transfemoral approach is preferred, but alternative access routes are needed for patients with prohibitive femoral anatomy.
• Carotid artery access has emerged as a potential alternative for TAVR.

Purpose of the Study:

• To evaluate the feasibility and safety of carotid access TAVR.
• To synthesize existing evidence through a meta-analysis of published cases.
• To provide data on key outcomes for this TAVR approach.

Main Methods:

• A comprehensive literature search was conducted across major databases (PubMed, EMBASE, CINAHL, Cochrane CENTRAL).
• Retrospective studies with at least 5 patients undergoing carotid access TAVR were included.
• A random-effects model was used to analyze outcomes including mortality, stroke, pacemaker implantation, and access site complications.

Main Results:

• The meta-analysis included 17 studies with 2082 patients, with a median follow-up of 1 month.
• Procedural success rate was high at 99%, with a 6.7% all-cause mortality rate.
• Key complication rates included TIA/stroke (3.9%), permanent pacemaker (PPM) implantation (16.7%), and major bleeding (7%).

Conclusions:

• The transcarotid approach is a feasible and safe alternative for TAVR in patients unsuitable for transfemoral access.
• This approach offers a viable solution for expanding TAVR accessibility.
• Further research may refine patient selection and procedural techniques for carotid TAVR.