Transcarotid versus transthoracic access for transcatheter aortic valve replacement: A Propensity Matched Analysis
The Journal of thoracic and cardiovascular surgery
cards; cards publication
ObjectiveTranscarotid (TC) access for transcatheter aortic valve replacement (TAVR) is emerging as an alternative to more traditional nonfemoral access options like transapical (TA) or transaortic (TAo); however, comparative data are limited. The purpose of the study was to analyze outcomes following TAVR using TC as compared to transthoracic (TA/TAo) access.
MethodsThe Society of Thoracic Surgeons / American College of Cardiology Transcatheter Valve Therapy Registry™ was queried for patients who underwent TC, TA, or TAo TAVR with the SAPIEN 3 transcatheter heart valve between June 2015 and July 2019. Thirty-day unadjusted outcomes were evaluated and propensity score matching and logistic regression were used to compare TC access with transthoracic access.
ResultsIn the propensity matched analysis, 667 TC TAVR procedures were compared to 1334 transthoracic procedures. TC TAVR was associated with lower mortality (4.2% vs 7.7%, p=0.004), less new-onset atrial fibrillation (2.2% vs 12.1%, p<0.0001), fewer readmissions at 30-days (9.8% vs 16.1%, p=0.0006), shorter median length of stay [(LOS) 3.0 days vs 6.0, p<0.0001], shorter median intensive care unit (ICU) stay (25 hours vs 47.2 hours, p<0.0001), and greater 30-day Kansas City Cardiomyopathy Questionnaire (KCCQ) score improvement from baseline (25.1 vs 20.8, p=0.007). Stroke (4.3% vs 3.7%, p=0.44) and major vascular complications (1.4% vs 1.9%, p=0.40) were similar.
ConclusionsTAVR using TC access is associated with lower 30-day mortality, less atrial fibrillation, shorter ICU and overall LOS, fewer readmissions, greater improvement in KCCQ scores and no significant difference in stroke or major vascular complications compared to transthoracic access.
Allen, Keith B.; Chhatriwalla, Adnan K.; Saxon, John; Hermiller, James; Heimansohn, David; Moainie, Sina; McKay, Raymond G.; Cheema, Mohiuddin; Jones, Brandon; Hodson, Robert W.; Korngold, Ethan C; and Kirker, Eric B, "Transcarotid versus transthoracic access for transcatheter aortic valve replacement: A Propensity Matched Analysis" (2020). Articles, Abstracts, and Reports. 3912.