Transcarotid Access for Transcatheter Aortic Valve Replacement With the Evolut Self-Expanding Valve: Outcomes from a Real-World Registry

BACKGROUND: Transcarotid access for transcatheter aortic valve replacement (TAVR) is the most commonly used alternate access in the United States. Real-world evidence on transcarotid access using the Evolut self-expanding valve based on larger numbers of patients may help inform treatment optimization towards better outcomes. METHODS: The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry™ was queried for patients undergoing native TAVR using transcarotid access with an Evolut (January 2015-December 2024). In-hospital, 30-day, and 1-year outcomes are reported. RESULTS: We identified 2,105 patients (mean age 78.3±7.9 years) with mean Society of Thoracic Surgeons predicted risk of mortality 6.4±5.3. Most were high/extreme surgical risk (60.0%) with New York Heart Association class III/IV heart failure symptoms (66.8%) and mean baseline Kansas City Cardiomyopathy Questionnaire (KCCQ) Score 45.3±25.4. Implant success was 99.6% primarily using general anesthesia (95.8%) with median procedure time of 88.0 (Q1=68.0, Q3=115.0) minutes. Median length of stay was 2.0 (Q1=1.0, Q3=3.0) days; 89.0% were discharged to home. In-hospital, 30-day and 1-year all-cause mortality was 2.1%, 3.8% and 16.5%; stroke occurred in 3.1%, 3.8% and 5.1% of patients, respectively. At 30 days, major vascular complications (1.9%), valve related (0.4%) and non-valve related (10.9%) readmissions were low. The mean change in KCCQ score from baseline to 1-year was +30.5±27.1 points. CONCLUSIONS: Transcarotid TAVR with the Evolut TAV is an effective, safe approach for patients with unfavorable iliofemoral anatomy. Heart teams should become facile with this technique to provide optimal care across the anatomy spectrum.