Key result
Transcarotid TAVR cuts 30-day MACE ~46% and major bleeding versus transthoracic TAVR.
Why the study?
Transthoracic approaches may be contraindicated in some patients and associated with poorer outcomes, leading to increased use of alternative access routes such as transcarotid TAVR.
Does transcarotid TAVR reduce 30-day MACE and bleeding compared to transthoracic TAVR in patients requiring alternative access?
Meta-Analysis (n=704)
Does transcarotid TAVR reduce 30-day MACE and bleeding compared to transthoracic TAVR in patients requiring alternative access?
Odds Ratio: 0.54 (95% CI 0.29–0.99)
Absolute Event Rate: 7.8% vs 13.7%
p-value: p=0.05
Transcarotid TAVR appears to be a safe alternative access route, associated with lower 30-day MACE and bleeding compared to transthoracic TAVR, with comparable mortality and stroke risks.
Transthoracic approaches may be contraindicated in some patients and may be associated with poorer outcomes. Therefore other alternative access routes are increasingly being performed. We conducted a systematic review of the literature on Transcarotid transcatheter aortic valve replacement (TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access routes. We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We presented data using risk ratios (95 % confidence intervals) and measured heterogeneity using Higgins' I 2 . Sixteen observational studies on Transcarotid TAVR were included in the analysis; 4 studies compared 180 TC-TAVR patients vs 524 TT-TAVR patients. The mean age and STS score for patients undergoing TC-TAVR were 80 years and 7.6 respectively. For TT-TAVR patients, the mean age and STS score were 79.7 years and 8.7 respectively. TC-TAVR patients had lower 30-day MACE [7.8 % vs 13.7 %; OR 0.54 (95 % CI 0.29–0.99, P = 0.05)] and major or life-threatening bleeding [4.0 % vs 14.2 %; OR 0.25 (95 % CI 0.09–0.67, P = 0.006)]. There was no significant difference in 30-day: mortality [5.0 % vs 8.6 %; OR 0.61 (95 % CI 0.29–1.30, P = 0.20)], stroke or transient ischemic attack [2.8 % vs 4.0 %; OR 0.65 (95 % CI 0.25–1.73, P = 0.39)] and moderate or severe aortic valve regurgitation [5.0 % vs 4.6 %; OR 1.14. (95 % CI 0.52–2.52, P = 0.75)]. There was a trend towards fewer major vascular complications in TC-TAVR [3.0 % vs 7.8 %; OR 0.42 (95 % CI 0.16–1.12, P = 0.08)]. Compared with transthoracic TAVR, TC-TAVR patients had lower odds of 30-day MACE and life-threatening bleeding and no differences in 30-day mortality, stroke or TIA, aortic valve regurgitation. • Transcarotid TAVR associated with lower 30-day mortality compared to Transthoracic TAVR • Stroke and TIA risk after Transcarotid TAVR is comparable to Transthoracic TAVR. • MACE Risk was lower in patients undergoing Transcarotid TAVR compared with Transthoracic TAVR.
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Munguti et al. (2024) conducted a meta-analysis in Aortic stenosis (n=704). Transcarotid transcatheter aortic valve replacement (TC-TAVR) vs. Transthoracic transcatheter aortic valve replacement (TT-TAVR) was evaluated on 30-day Major Adverse Cardiovascular Events (MACE) (OR 0.54, 95% CI 0.29-0.99, p=0.05). Transcarotid transcatheter aortic valve replacement reduced the odds of 30-day MACE (OR 0.54) and major or life-threatening bleeding compared to transthoracic approaches.
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