Related Experiment Video
Updated: May 6, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Transfemoral Versus Transcarotid Transcatheter Aortic Valve Replacement Under Locoregional Anesthesia: A
Antonio D'Errico Ramirez1, Enrico Squiccimarro2, Paolo Pagano3
1Division of Cardio-Thoracic Surgery, Centre Hospitalier Universitaire Reims, Reims, France.
Objectives:
To evaluate the safety and efficacy of transcarotid transcatheter aortic valve replacement (TC-TAVR) performed under locoregional anesthesia compared with the standard transfemoral (TF) approach (transfemoral transcatheter aortic valve replacement [TF-TAVR]), with a particular focus on neurologic outcomes and validation of transcarotid (TC) access as a viable alternative access route.
Design:
A retrospective, single-center, observational cohort study with propensity score matching.
Setting:
A tertiary care academic institution with a high-volume structural heart disease program: Reims University Hospital, France.
Participants:
A total of 868 patients who underwent transcatheter aortic valve replacement between January 2017 and September 2023 were included. Of these, 707 underwent TF-TAVR and 161 underwent TC-TAVR. After 1:1 propensity score matching, 135 matched pairs were analyzed.
Interventions:
All procedures were performed under local or locoregional anesthesia with conscious sedation. TC access was achieved via surgical cervicotomy and temporary carotid clamping; TF access was performed percutaneously. Neurologic monitoring was routinely applied in TC-TAVR cases.
Measurements And Main Results:
Primary endpoints included 30-day, 1-year, and 2-year all-cause mortality, as well as stroke or transient ischemic attack (TIA). After matching, early mortality and mid-term mortality were comparable between groups (30 days: 1.5% in TC group v 3.7% in TF group, p = 0.447; 2 years: 5.9% in TC group v 7.4% in TF group, p = 0.807). Stroke occurred more frequently in the TC group (3.7% v 0.7%), but this was not statistically significant (p = 0.214). No TIAs were observed. Secondary complications, including vascular and pacemaker implantation rates, were similarly distributed.
Conclusions:
TC-TAVR under locoregional anesthesia is a safe and effective alternative to TF-TAVR, with comparable mortality and neurologic outcomes. It should be considered a valid access route in patients with contraindications to TF access.
