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Published online: 2021-07-02
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Comparison of transcarotid versus transapical transcatheter aortic valve implantation outcomes in patients with severe aortic stenosis and contraindications for transfemoral access

Damian Hudziak, Radosław Targoński, Wojciech Wańha, Radosław Gocoł, Adrianna Hajder, Radosław Parma, Tomasz Figatowski, Tomasz Darocha, Marek A. Deja, Wojciech Wojakowski, Dariusz Jagielak
DOI: 10.5603/CJ.a2021.0071
·
Pubmed: 34308536

open access

Ahead of print
Original articles
Published online: 2021-07-02

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).

Conclusion: Both TC and TA TAVI are safe procedures in appropriately selected patients and are associated with a low risk of complications.

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).

Conclusion: Both TC and TA TAVI are safe procedures in appropriately selected patients and are associated with a low risk of complications.

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Keywords

aortic stenosis, transcarotid access, transapical access, transcatheter aortic valve implantation (TAVI)

About this article
Title

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

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-07-02

DOI

10.5603/CJ.a2021.0071

Pubmed

34308536

Keywords

aortic stenosis
transcarotid access
transapical access
transcatheter aortic valve implantation (TAVI)

Authors

Damian Hudziak
Radosław Targoński
Wojciech Wańha
Radosław Gocoł
Adrianna Hajder
Radosław Parma
Tomasz Figatowski
Tomasz Darocha
Marek A. Deja
Wojciech Wojakowski
Dariusz Jagielak

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