Transcarotid Versus Transfemoral Transcatheter Aortic Valve Replacement (from a Propensity-Matched Comparison)

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Surgical Outcomes Research

Background:

• Transcatheter aortic valve replacement (TAVR) is a crucial treatment for aortic stenosis.
• Previous comparisons of transcarotid (TC) and transfemoral (TF) TAVR access routes have yielded inconsistent results.
• Optimal TAVR access strategies require further investigation to improve patient outcomes.

Purpose of the Study:

• To compare in-hospital and 1-year clinical outcomes between TC and TF TAVR.
• To evaluate changes in quality of life and direct hospital costs for both approaches.
• To determine the safety and efficacy of the TC approach as an alternative to TF access.

Main Methods:

• A comparative study of 138 TC procedures versus 1,926 TF procedures for TAVR.
• Propensity matching based on the Society of Thoracic Surgery Predicted Risk of Mortality was used to create comparable cohorts (130 TC vs. 813 TF).
• Outcomes assessed included in-hospital mortality, stroke, vascular complications, bleeding, pacemaker requirement, length of stay, hospital costs, 1-year mortality, readmission, and quality of life (Kansas City Cardiomyopathy Questionnaire).

Main Results:

• No significant differences were observed between matched TC and TF cohorts in in-hospital mortality (0.0% vs. 1.4%), stroke (2.3% vs. 2.5%), major vascular complications (0.8% vs. 2.2%), bleeding complications (4.6% vs. 6.4%), or pacemaker requirement (14.6% vs. 12.9%).
• Postoperative hospital length of stay (3.3 vs. 3.1 days) and direct hospital costs ($52,899 vs. $50,464) were also comparable between the groups.
• At 1-year follow-up, no significant differences were found in all-cause mortality (7.6% vs. 6.4%), hospital readmission (20.0% vs. 23.9%), or quality of life scores (84.0 vs. 88.4).

Conclusions:

• The transcarotid (TC) approach for TAVR demonstrates comparable safety and efficacy to the transfemoral (TF) approach.
• TC TAVR is associated with similar in-hospital complications, length of stay, hospital costs, and 1-year clinical outcomes as TF TAVR.
• These findings support the transcarotid approach as an optimal alternative access route for patients undergoing transcatheter aortic valve replacement, particularly when transfemoral access is not feasible.