Key result
Transcarotid TAVR had a lower 30-day rate of death, stroke/TIA, or hospitalization than SAVR (4.3% vs 12.6%; HR for SAVR 2.93, 95% CI 1.45-5.94), with no significant difference at 1 year.
Why the study?
Although guidelines recommend SAVR for severe aortic stenosis with unfavorable iliofemoral access, and TC-TAVR has emerged as an alternative, comparative data between TC-TAVR and SAVR were lacking.
Does transcarotid transcatheter aortic valve replacement improve clinical outcomes compared to surgical aortic valve replacement in patients with severe aortic stenosis?
Cohort (n=786)
Does transcarotid transcatheter aortic valve replacement improve clinical outcomes compared to surgical aortic valve replacement in patients with severe aortic stenosis?
Transcarotid TAVR is associated with improved 30-day clinical outcomes compared to SAVR, with similar outcomes at 1 year, suggesting it is a valid alternative for patients with severe aortic stenosis and unfavorable transfemoral access.
BACKGROUND: Current guidelines recommend surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis and unfavorable iliofemoral access. Transcarotid transcatheter aortic valve replacement (TC-TAVR) has emerged as an alternative access in suboptimal transfemoral candidates, but no data exist comparing TC-TAVR and SAVR. The main objective of this study was to compare the clinical outcomes in a propensity-matched population of TC-TAVR and SAVR patients with severe aortic stenosis. METHODS: A total of 786 patients (SAVR, 352; TC-TAVR, 434) were included, and a total of 182 patients were propensity-matched and included in each group. The primary outcome was a composite of death from any cause, stroke/transient ischemic attack, and procedure-related or valve-related hospitalization at 30 days and at 1 year. Data were prospectively collected in dedicated databases, and clinical events were defined according to Valve Academic Research Consortium-3 criteria. RESULTS: Baseline characteristics were well balanced between the matched groups, and the mean age and Society for Thoracic Surgeons score of the study population were 75 years and 3.6%, respectively. At 30 days, the SAVR group showed a higher rate of the primary composite outcome compared with the TC-TAVR group (12.6% versus 4.3%; hazard ratio, 2.93 [95% CI, 1.45–5.94]). Acute kidney injury stages 2 to 4, bleeding events, and new-onset atrial fibrillation occurred more often in the SAVR group during the hospital period ( P <0.001). In contrast, vascular complications and the need for permanent pacemaker implantation occurred more often in the TC-TAVR group ( P =0.01 and P =0.001, respectively). At 1-year follow-up, there were no significant differences between groups in the primary outcome rates (SAVR, 19.7% versus TC-TAVR, 12.7%; hazard ratio, 1.63 [95% CI, 0.98–2.73]). CONCLUSIONS: TC-TAVR was associated with improved 30-day clinical outcomes compared with SAVR, with no significant differences in death, stroke, and hospitalization at 1-year follow-up. These findings suggest that TC-TAVR may be a valid alternative to SAVR in nontransfemoral-TAVR candidates.
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Portillo et al. (2025) conducted a cohort in severe aortic stenosis (n=786). Transcarotid transcatheter aortic valve replacement (TC-TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Composite of death from any cause, stroke/transient ischemic attack, and procedure-related or valve-related hospitalization at 30 days and at 1 year (HR 2.93, 95% CI 1.45-5.94). Transcarotid TAVR had a lower 30-day rate of death, stroke/TIA, or hospitalization than SAVR (4.3% vs 12.6%; HR for SAVR 2.93, 95% CI 1.45-5.94), with no significant difference at 1 year.
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