Key result
Alternative access TAVR showed higher mortality in the transapical group and higher stroke rates in the transaxillary group, suggesting transcarotid TAVR as the preferred alternative access.
Why the study?
While many centers have a preferred alternative access site for TAVR, few papers have compared the outcomes of TAVR across each alternative access site.
How do outcomes compare among transcaval, transaxillary, transcarotid, and transapical access sites for TAVR?
How do outcomes compare among transcaval, transaxillary, transcarotid, and transapical access sites for TAVR?
Transcarotid access may represent the preferred secondary approach for TAVR when alternative access is required, avoiding the higher mortality of transapical and higher stroke risk of transaxillary approaches.
Answers are grounded in this paper and cite their sources.
Supports transcarotid preference among alternative TAVR accesses; leaves open need for randomized confirmation.
Alternative access transcatheter aortic valve replacement (TAVR) consists primarily of 4 different options: transcaval, transaxillary, transcarotid, and transapical. While many centers have a preferred alternative access site, few papers have compared the outcomes of TAVR with each alternative access site. In this review, we examine the outcomes of TAVR at each alternative access site, focusing on mortality, stroke, bleeding, pacemaker insertion, paravalvular leakage, and discharge to home. Notable findings include higher mortality in the transapical group and higher stroke rate in the transaxillary group. On the basis of these data, we suggest that transcarotid TAVR might represent the second choice of approach for TAVR when alternate access is required.
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Waterford et al. (2023) conducted a review in Aortic valve disease requiring alternative access TAVR. Alternative access TAVR (transcaval, transaxillary, transcarotid, transapical) vs. Comparison between alternative access sites was evaluated on Mortality, stroke, bleeding, pacemaker insertion, paravalvular leakage, and discharge to home. Alternative access TAVR showed higher mortality in the transapical group and higher stroke rates in the transaxillary group, suggesting transcarotid TAVR as the preferred alternative access.
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