Long-Term Clinical Outcomes and Carotid Ultrasound Follow-Up of Transcarotid TAVI. Prospective Single-Center Registry

Area of Science:

• Cardiology
• Vascular Surgery
• Medical Imaging

Background:

• Transcatheter aortic valve implantation (TAVI) is a key treatment for aortic stenosis.
• Transcarotid access (TC-TAVI) offers an alternative to transfemoral (TF) access.
• Cerebral oximetry monitoring during TC-TAVI is utilized to assess cerebral perfusion.

Purpose of the Study:

• To prospectively evaluate the safety and long-term clinical outcomes of cerebral oximetry-guided TC-TAVI.
• To assess the incidence of in-hospital and long-term adverse events.
• To monitor for carotid artery changes using systematic carotid ultrasound follow-up.

Main Methods:

• Prospective evaluation of 33 TC-TAVI procedures performed between 2017 and 2019.
• In-hospital outcome analysis including mortality, myocardial infarction, cardiac tamponade, arrhythmias, and pacing requirements.
• Long-term follow-up (mean 19.5 months) including mortality, echocardiography, carotid Doppler ultrasound, and VARC-2 defined events.

Main Results:

• One intraoperative death and one transient ischemic attack (TIA).
• In-hospital postoperative events included myocardial infarction (3.0%), cardiac tamponade (3.0%), new-onset atrial fibrillation (6.3%), temporary pacing (27.3%), and pacemaker implantation (15%).
• Two-year survival rate was 83% ± 14%. No significant changes in echocardiographic parameters or significant carotid artery narrowing were observed on ultrasound. Mean peak systolic velocity (PSV) in carotid arteries was approximately 71 cm/s.

Conclusions:

• Cerebral oximetry-guided TC-TAVI is a safe procedure with favorable long-term clinical outcomes.
• The technique does not appear to increase the risk of plaque formation or significant stenosis in the carotid arteries.
• TC-TAVI may be considered a primary alternative to TF access in carefully selected patients.