Suitability for Transcarotid Transcatheter Aortic Valve Replacement in the Japanese Population

Transcarotid (TC) transcatheter aortic valve replacement (TAVR) has shown favorable outcomes in selected Western populations; however, data on its suitability in patients undergoing TAVR remain scarce.

The purpose of this study was to investigate the anatomical characteristics of the common carotid artery (CCA) and the suitability of Japanese patients for TC-TAVR.

This single-center retrospective study included consecutive patients who underwent TAVR between April 2023 and March 2024. Patients were categorized into a tough-transfemoral (TF) group, who may require an alternative approach, and a viable-TF group. TC-TAVR suitability was determined based on the CCA diameter, exposure site calcification, atherosclerotic plaque, and contralateral carotid artery stenosis.

Among 336 patients, the right CCA was larger than the left CCA (6.6 ± 1.0 mm vs 6.4 ± 0.9 mm; P < 0.001) but exhibited greater tortuosity (44 of 336 [13.1%; 95% CI: 9.9%-17.1%] vs 9 of 336 [2.7%; 95% CI: 1.4%-5.0%]; P < 0.001). The tough-TF group had a higher incidence of major vascular complications (12 of 117 [10.3%; 95% CI: 6.0%-17.1%]) compared with the viable-TF group (3 of 219 [1.4%; 95% CI: 0.5%-3.9%]; P < 0.001). Overall suitability for TC-TAVR was high (306 of 336 [91.1%; 95% CI: 87.5%-93.7%]); however, it was significantly lower in the tough-TF group than in the viable-TF group (101 of 117 [86.3%; 95% CI: 78.9%-91.4%] vs 205 of 219 [93.6%; 95% CI: 89.6%-96.2%]; P = 0.042). Multivariate regression analysis identified peripheral artery disease as a negative predictor of suitability (OR: 0.42; 95% CI: 0.19-0.99; P = 0.039).

Although TC-TAVR suitability was compromised in the tough-TF group, 86% remained suitable, suggesting that TC-TAVR may serve as a promising approach in the Japanese population.