Outcome of transcarotid versus transthoracic access for transcatheter aortic valve replacement

Q: What are the key findings of this study?

Transcarotid TAVR access yielded comparable 5-year survival (70.1% vs 54.3%, p=0.47) and 30-day mortality (5.3% vs 13.2%, p=0.27) to transthoracic access, with lower new-onset AF (0% vs 10.5%, p=0.04).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe symptomatic aortic stenosis undergoing nonfemoral transcatheter aortic valve replacement (n=155). Intervention: Transcarotid (TC) access for TAVR vs. Transthoracic (TT) access (transapical or transaortic) for TAVR. Primary outcome: Cumulative survival rate at 5 years (propensity-matched cohort) (p=0.47).

Q: What does this research mean for the field?

Transcarotid access for transcatheter aortic valve replacement results in comparable short- and mid-term survival to transthoracic access, while significantly reducing new-onset atrial fibrillation and length of hospital stay. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Chikashi Nakai; Junyi Liu; Asavari Gowda; Saeed Tarabichi; Shahid Khan; Kamal Singh; Krzysztof Drzymalski; Augustin Delago

doi:10.21203/rs.3.rs-10789420/v1

October 14, 2026Open Access

Outcome of transcarotid versus transthoracic access for transcatheter aortic valve replacement

View Full Paper

Ask AI

Bookmark

Share

Key result

Transcarotid TAVR matches transthoracic access for 5-year survival, with lower new-onset AF.

P=0.47
n=155

Why the study?

While short-term outcomes of TAVR via alternative transcarotid and transthoracic access routes have been reported for patients not feasible for transfemoral access, mid- to long-term outcomes comparing these approaches were poorly documented.

Does transcarotid access improve perioperative outcomes and 5-year survival compared to transthoracic access in patients undergoing transcatheter aortic valve replacement who are not candidates for transfemoral access?

Key Points

To compare short- and mid-term postoperative outcomes between transcarotid and transthoracic access routes for transcatheter aortic valve replacement in patients ineligible for transfemoral access.
Propensity score matching (1:1 nearest neighbor method) created 38 matched pairs to balance baseline characteristics.
Mean follow-up duration was 2.3 ± 2.1 years, with assessments of perioperative complications, length of stay, and 5-year survival.
Postoperative new-onset atrial fibrillation was significantly lower in the transcarotid group than the transthoracic group (0% vs 10.5%, p = 0.04).
Length of hospital stay was significantly shorter for transcarotid access compared to transthoracic access (4.9 ± 5.5 days vs 7.7 ± 4.8 days, p = 0.02).
There were no statistically significant differences in 30-day mortality (5.3% vs 13.2%, p = 0.27) or 5-year cumulative survival (70.1% vs 54.3%, p = 0.47, adjusted HR 1.38, 95% CI 0.58–3.29).

Study Design

Type

Cohort (n=155)

Multicenter

No

Structured PICO

Does transcarotid access improve perioperative outcomes and 5-year survival compared to transthoracic access in patients undergoing transcatheter aortic valve replacement who are not candidates for transfemoral access?

P

Population

155 older adults (mean age 79.1 years, 47.7% female; 38 propensity-matched pairs) with severe aortic stenosis unsuitable for transfemoral TAVR undergoing transcarotid or transthoracic TAVR, followed for a mean of 2.3 years.

E

Exposure

Transcatheter aortic valve replacement (TAVR) via transcarotid (TC) access using the SAPIEN 3 balloon-expandable valve

C

Comparator

Transcatheter aortic valve replacement (TAVR) via transthoracic (TT) access (including transapical [n=54] and transaortic [n=6] approaches) using the SAPIEN 3 balloon-expandable valve

O

Outcome

Early mortality (defined as mortality within 30 days from TAVR procedure) and cumulative survival rates at 5 yearshard clinical

Main Result

Absolute Event Rate: 70.1% vs 54.3%

p-value: p=0.47

In patients undergoing TAVR without feasible transfemoral access, transcarotid access lowers postoperative new-onset atrial fibrillation and shortens hospital stay compared with transthoracic access while achieving comparable short- and mid-term survival.

Limitations

Retrospective single-center design subject to selection bias and residual confounding
Relatively modest sample size (38 propensity-matched pairs) limiting statistical power for mortality and infrequent clinical events
Significant residual difference in STS predicted risk scores between matched groups (5.1±3.0 TC vs 8.3±5.8 TT, p<0.01)
Variable follow-up duration and potential survivor bias inflating late cardiac readmission rates in the transcarotid group
Retrospective single-center analysis subject to inherent selection bias and residual confounding
Relatively modest sample size limiting statistical power for mortality and other infrequent clinical events
Incomplete balancing of baseline operative risk despite propensity score matching, with a significant difference remaining in STS predicted risk scores (5.1±3.0 TC vs 8.3±5.8 TT, p<0.01)
Varying follow-up duration among patients and survivor bias that likely inflated the cumulative readmission rate within the TC access group

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Transcarotid TAVR access merits no practice change yet; leaves open confirmation of benefits in randomized trials.

Abstract

Backgrounds: Short-term outcome of transcatheter aortic valve replacement (TAVR) through transcarotid access (TC) and transthoracic access (TT) such as transapical or transaortic has been reported as alternative access options in patients who were not feasible with transfemoral access. However, mid to long-term outcomes have been poorly documented. The purpose of this study was to evaluate postoperative outcomes comparing TC with TT groups. Methods Between January 2016 and January 2024, 93 patients underwent TAVR through TC access while 62 through TT access. To adjust baseline differences, 1:1 propensity score matching was performed using the nearest neighbor method between the TC and TT groups. Results 38 pairs were matched in propensity score matching. A significant higher incidence of postoperative new atrial fibrillation was detected in the TT compared with TC groups (10.5% vs 0%, p = 0.04). 30-day mortality rate, postoperative stroke, permanent pacemaker placement, and surgical reintervention for access site did not differ between the two groups. Length of hospital stay was shorter in the TC group (4.9 ± 5.5days vs 7.7 ± 4.8days, p = 0.02). Mean follow-up term was 2.3 ± 2.1years. Cumulative survival rate in 5 years was 70.1% in the TC group and 54.3% in the TT group. There was no significant difference in mid-term outcome between the 2 groups (p = 0.47). Conclusions Transcatheter aortic valve replacement through transcarotid access was associated with lower rate of new postoperative atrial fibrillation and shorter hospital stay compared with transthoracic access. However, short and mid-term survival rates were comparable in this patient cohort.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Nakai et al. (2026) conducted a cohort in Severe symptomatic aortic stenosis undergoing nonfemoral transcatheter aortic valve replacement (n=155). Transcarotid (TC) access for TAVR vs. Transthoracic (TT) access (transapical or transaortic) for TAVR was evaluated on Cumulative survival rate at 5 years (propensity-matched cohort) (p=0.47). Transcarotid TAVR access yielded comparable 5-year survival (70.1% vs 54.3%, p=0.47) and 30-day mortality (5.3% vs 13.2%, p=0.27) to transthoracic access, with lower new-onset AF (0% vs 10.5%, p=0.04).

synapsesocial.com/papers/6ae28f41cbadf70daf6c447a https://doi.org/10.21203/rs.3.rs-10789420/v1

View Full Paper

Ask AI

Bookmark

Share

Outcome of transcarotid versus transthoracic access for transcatheter aortic valve replacement

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Outcome of transcarotid versus transthoracic access for transcatheter aortic valve replacement

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading