Key result
Transcarotid TAVR resulted in a lower rate of vascular complications compared to transfemoral TAVR (2.3% vs 3.9%; OR 2.22; 95% CI 1.13-4.38; p=0.02), with no significant difference in 30-day mortality.
Why the study?
Carotid access has shown promise as a delivery route for TAVR, but comparative evidence on its safety and effectiveness versus transfemoral access needed synthesis.
Does transcarotid TAVR reduce complications compared to transfemoral TAVR in patients undergoing TAVR?
Meta-Analysis (n=2,470)
Does transcarotid TAVR reduce complications compared to transfemoral TAVR in patients undergoing TAVR?
Odds Ratio: 2.22 (95% CI 1.13–4.38)
Absolute Event Rate: 2.3% vs 3.9%
p-value: p=0.02
Transcarotid TAVR is a safe and effective alternative to transfemoral TAVR, associated with comparable clinical outcomes and a lower rate of vascular complications.
May favor transcarotid access to reduce vascular complications in suitable TAVR patients; supports randomized trials to confirm safety.
BACKGROUND: Carotid access has shown promise as an excellent delivery route for transcatheter aortic valve replacement (TAVR). We aimed to compare outcomes of transcarotid (TC) and transfemoral (TF) TAVR by conducting a search and analysis of the best evidence in the literature to shed light on its safety and effectiveness. METHODS: The PubMed/MEDLINE, Embase, and Cochrane library from inception to July 2020 were searched to identify articles reporting comparative data on TC versus TF approaches for TAVR. Patients' baseline characteristics and clinical outcomes were extracted from the articles and pooled for analysis. RESULTS: Five studies, including a total of 2470 patients, were included in the study with 1859 patients in the TF group and 611 patients in the TC group. The TC group had higher prevalence of peripheral vascular disease, while the patients in the TF group was older. Meta-analysis revealed that there was no significant differences between the two groups with regard to 30-day mortality (p = 0.09), stroke (p = 0.28), new dialysis (p = 0.58), major bleeding (p = 0.69), or pacemaker implantation (p = 0.44). The TF group had a higher incidence of vascular complications (3.9% vs. 2.3%; OR 2.22; 95% CI [1.13, 4.38]; p = 0.02). CONCLUSIONS: Compared with the TF approach, TC-TAVR is associated with comparable procedural and clinical outcomes. Our analysis found a lower rate of vascular complication in TC access compared with TF access. This supports consideration of such an alternative access when there are concerns over the feasibility of TF access.
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McGrath et al. (2021) conducted a meta-analysis in Transcatheter aortic valve replacement (TAVR) (n=2,470). Transcarotid (TC) TAVR vs. Transfemoral (TF) TAVR was evaluated on Vascular complications (OR 2.22, 95% CI 1.13-4.38, p=0.02). Transcarotid TAVR resulted in a lower rate of vascular complications compared to transfemoral TAVR (2.3% vs 3.9%; OR 2.22; 95% CI 1.13-4.38; p=0.02), with no significant difference in 30-day mortality.
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