Comparison of transcarotid versus transapical transcatheter aortic valve implantation outcomes in patients with severe aortic stenosis and contraindications for transfemoral access

Abstract

BACKGROUND: The purpose of this study was to compare the safety and clinical outcomes of transcarotid
(TC) and transapical access (TA) transcatheter aortic valve implantation (TAVI) patients whom the
transfemoral approach (TF) was not feasible.
METHODS: The analysis included consecutive patients with severe symptomatic aortic stenosis treated
from 2017 to 2020 with TC-TAVI or TA-TAVI in two high-volume TAVI centers. The approach was
selected by multidisciplinary heart teams after analyzing multislice computed tomography of the heart,
aorta and peripheral arteries, transthoracic echocardiography and coronary angiography.
RESULTS: One hundred and two patients were treated with alternative TAVI accesses (TC; n = 49 and
TA; n = 53) in our centers. The groups were similar regarding age, gender, New York Heart Association
class, and echocardiography parameters. Patients treated with TC-TAVI had significantly higher
surgical risk. The procedural success rate was similar in both groups (TC-TAVI 98%; TA-TAVI 98.1%;
p = 0.95). The rate of Valve Academic Research Consortium-2 defined clinical events was low in both
groups. The percentage of new-onset rhythm disturbances and permanent pacemaker implantation was
similar in TC and TA TAVI (4.1% vs. 11.3%; p = 0.17 and 10.2% vs. 5.7%; p = 0.39, respectively).
In the TA-TAVI group, significantly more cases of pneumonia and blood transfusions were observed
(11% vs. 0%; p = 0.01 and 30.2% vs. 12.2%; p = 0.03). The 30-day mortality was similar in TC and
TA groups (4.1% vs. 5.7%; p = 0.71, respectively).
CONCLUSIONS: Both TC and TA TAVI are safe procedures in appropriately selected patients and are
associated with a low risk of complications.