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Nationwide experience with transcarotid transcatheter aortic valve implantation: Insights from the POL-CAROTID registry

Radoslaw Wilimski1, Zenon Huczek2, Kajetan Grodecki2, Janusz Kochman2, Bartosz Rymuza2, Wojciech Wojakowski3, Damian Hudziak3, Dariusz Jagielak4, Jerzy Sacha56, Marek Grygier7, Andrzej Walczak8, Piotr Hendzel1, Romuald Cichoń9, Marcin Grabowski2, Mariusz Kuśmierczyk1
DOI: 10.33963/KP.a2022.0288
·
Pubmed: 36594529
Affiliations
  1. Department of Cardiac Surgery, Medical University of Warsaw, Warszawa, Poland
  2. 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
  3. Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland
  4. Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
  5. Department of Cardiology, University Hospital, Faculty of Natural Sciences and Technology, University of Opole, Opole, Poland
  6. Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
  7. 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
  8. Department of Cardiac Surgery, Medical University of Lodz, Łódź, Poland
  9. Department of Cardiac Surgery, Medical University of Zielona Góra, Zielona Góra, Poland

open access

Online first
Original article
Published online: 2022-12-16

Abstract

BACKGROUND: :: To investigate the feasibility and safety of transcarotid (TC) access for transcatheter aortic valve implantation (TAVI) in comparison to the transfemoral (TF) approach in a multicenter setting.

METHODS: :: A total of 41 patients, treated between December 2014 and December 2018, were retrospectively reported to the Polish Registry of Common Carotid Artery Access for TAVI (POL-CAROTID). The median follow-up time was 619 (365 – 944) days and Valve Academic Research Consortium-2 (VARC-2) definitions were applied. Clinical outcomes were compared with 41 propensity-matched TF-TAVI patients.

RESULTS: :: The mean (SD) patients' age was 78.0 (7.2) years and 29 patients (70.7%) were men. Prohibitive iliofemoral anatomy and/or obesity (46.3%) and/or the presence of stent graft in the abdominal aorta (31.7%) were the most common indications for TC-TAVI. Device success for TC-TAVI was comparable with matched TF-TAVI group (90.2% vs 95.3%, P=0.396) and no periprocedural mortality was observed. Moreover, early safety was similar between the two groups (92.7% vs 95.3%, respectively, log-rank P=0.658) with only 1 case of non-disabling stroke during the first month after TC-TAVI. Consequently, no cerebrovascular events were observed in the mid-term, and the clinical efficacy of TC-TAVI corresponded well with TF-TAVI (90.2% vs 92.7%, log-rank P=0.716). A total of 4 (9.8%) deaths were noted in the TC-TAVI cohort in comparison to 3 (7.3%) in the TF-TAVI group.

CONCLUSIONS: :: The results of the study indicated that the first cohort of transcarotid transcatheter heart valves of second-generation implantations in Poland were associated with a similar prognosis to TF-TAVI with regard to safety and feasibility. TC access may be considered an optimal alternative for patients, in whom the TF approach is precluded.

Abstract

BACKGROUND: :: To investigate the feasibility and safety of transcarotid (TC) access for transcatheter aortic valve implantation (TAVI) in comparison to the transfemoral (TF) approach in a multicenter setting.

METHODS: :: A total of 41 patients, treated between December 2014 and December 2018, were retrospectively reported to the Polish Registry of Common Carotid Artery Access for TAVI (POL-CAROTID). The median follow-up time was 619 (365 – 944) days and Valve Academic Research Consortium-2 (VARC-2) definitions were applied. Clinical outcomes were compared with 41 propensity-matched TF-TAVI patients.

RESULTS: :: The mean (SD) patients' age was 78.0 (7.2) years and 29 patients (70.7%) were men. Prohibitive iliofemoral anatomy and/or obesity (46.3%) and/or the presence of stent graft in the abdominal aorta (31.7%) were the most common indications for TC-TAVI. Device success for TC-TAVI was comparable with matched TF-TAVI group (90.2% vs 95.3%, P=0.396) and no periprocedural mortality was observed. Moreover, early safety was similar between the two groups (92.7% vs 95.3%, respectively, log-rank P=0.658) with only 1 case of non-disabling stroke during the first month after TC-TAVI. Consequently, no cerebrovascular events were observed in the mid-term, and the clinical efficacy of TC-TAVI corresponded well with TF-TAVI (90.2% vs 92.7%, log-rank P=0.716). A total of 4 (9.8%) deaths were noted in the TC-TAVI cohort in comparison to 3 (7.3%) in the TF-TAVI group.

CONCLUSIONS: :: The results of the study indicated that the first cohort of transcarotid transcatheter heart valves of second-generation implantations in Poland were associated with a similar prognosis to TF-TAVI with regard to safety and feasibility. TC access may be considered an optimal alternative for patients, in whom the TF approach is precluded.

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Keywords

aortic stenosis, transcatheter aortic valve implantation, transcarotid access

About this article
Title

Nationwide experience with transcarotid transcatheter aortic valve implantation: Insights from the POL-CAROTID registry

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-12-16

Page views

111

Article views/downloads

50

DOI

10.33963/KP.a2022.0288

Pubmed

36594529

Keywords

aortic stenosis
transcatheter aortic valve implantation
transcarotid access

Authors

Radoslaw Wilimski
Zenon Huczek
Kajetan Grodecki
Janusz Kochman
Bartosz Rymuza
Wojciech Wojakowski
Damian Hudziak
Dariusz Jagielak
Jerzy Sacha
Marek Grygier
Andrzej Walczak
Piotr Hendzel
Romuald Cichoń
Marcin Grabowski
Mariusz Kuśmierczyk

References (17)
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