November 1, 2018Circulation Cardiovascular Interventions
Transcarotid Compared With Other Alternative Access Routes for Transcatheter Aortic Valve Replacement
Key result
Transcarotid TAVR had similar 30-day all-cause mortality (2.1% vs 4.6%; P=0.37) but significantly less new-onset atrial fibrillation (3.2% vs 19.0%; P=0.002) compared with thoracic approaches.
Why the study?
Does transcarotid TAVR improve 30-day clinical outcomes in patients undergoing alternative-access TAVR compared to transapical or transaortic approaches?
Population
329 patients undergoing transcatheter aortic valve replacement who are not candidates for a transfemoral…
Comparison
Transcarotid TAVR vs Transapical or transaortic TAVR
Design
Cohort
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Transcarotid access may reduce AF and length of stay in alternative TAVR; extends observational data but leaves open randomized confirmation.
Study Design
Type
Cohort (n=329)
Multicenter
Yes
Structured PICO
Does transcarotid TAVR improve 30-day clinical outcomes in patients undergoing alternative-access TAVR compared to transapical or transaortic approaches?
P
Population
329 patients undergoing alternative-access TAVR who are not candidates for a transfemoral approach, evaluated for 30-day clinical outcomes.
E
Exposure
Transcarotid TAVR (performed under general anesthesia, mainly using the left common carotid artery)
C
Comparator
Transapical or transaortic TAVR
O
Outcome
Preprocedural success and 30-day clinical outcomes (including all-cause mortality, stroke, new pacemaker implantation, major vascular complications, new-onset atrial fibrillation, major or life-threatening bleeding, acute kidney injury, and length of hospital stay)hard clinical
Main Result
Absolute Event Rate: 2.1% vs 4.6%
p-value: p=0.37
Transcarotid TAVR offers a safe alternative access route with lower risks of atrial fibrillation, major bleeding, and acute kidney injury compared to thoracic approaches.
Limitations
- Non-randomized observational design
Cite This Study
Chamandi et al. (2018) conducted a cohort in Aortic valve disease requiring alternative-access TAVR (n=329). Transcarotid TAVR vs. Transapical or transaortic TAVR was evaluated on 30-day all-cause mortality (p=0.37). Transcarotid TAVR had similar 30-day all-cause mortality (2.1% vs 4.6%; P=0.37) but significantly less new-onset atrial fibrillation (3.2% vs 19.0%; P=0.002) compared with thoracic approaches.