Transcarotid Transcatheter Aortic Valve Replacement: Feasibility and Safety

JACC Cardiovasc Interv. 2016 Mar 14;9(5):472-80. doi: 10.1016/j.jcin.2015.11.045.

Abstract

Objectives: The purpose of this study was to assess the feasibility and safety of transcarotid transcatheter aortic valve replacement (TAVR).

Background: Many candidates for TAVR have challenging vascular anatomy that precludes transfemoral access. Transcarotid arterial access may be an option for such patients.

Methods: The French Transcarotid TAVR Registry is a voluntary database that prospectively collected patient demographics, procedural characteristics, and clinical outcomes among patients undergoing transcarotid TAVR. Outcomes are reported according to the updated Valve Academic Research Consortium criteria.

Results: Among 96 patients undergoing transcarotid TAVR at 3 French sites (2009 to 2013), the mean age and Society of Thoracic Surgeons predicted risk of mortality were 79.4 ± 9.2 years and 7.1 ± 4.1%, respectively. Successful carotid artery access was achieved in all patients. The Medtronic CoreValve (Medtronic, Inc., Minneapolis, Minnesota) (n = 89; 92.7%) and Edwards SAPIEN valves (Edwards Lifesciences, Irvine, California) (n = 7; 7.3%) were used. Procedural complications included: valve embolization (3.1%), requirement for a second valve (3.1%), and tamponade (4.2%). There were no major bleeds or major vascular complications related to the access site. There were 3 (3.1%) procedural deaths and 6 (6.3%) deaths at 30 days. The 1-year mortality rate was 16.7%. There were 3 (3.1%) cases of Valve Academic Research Consortium-defined in-hospital stroke (n = 0) or transient ischemic attack (TIA) (n = 3). None of these patients achieved the criteria for stroke and none manifested new ischemic lesions on cerebral computed tomography or magnetic resonance imaging. At 30 days, a further 3 TIAs were observed, giving an overall stroke/TIA rate of 6.3%.

Conclusions: Transcarotid vascular access for TAVR is feasible and is associated with encouraging short- and medium-term clinical outcomes. Prospective studies are required to ascertain if transcarotid TAVR yields equivalent results to other nonfemoral vascular access routes.

Keywords: aortic stenosis; carotid vascular access; transcatheter aortic valve replacement.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / therapy*
  • Aortic Valve* / diagnostic imaging
  • Aortic Valve* / physiopathology
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / instrumentation
  • Cardiac Catheterization / methods*
  • Cardiac Catheterization / mortality
  • Carotid Artery, Common* / diagnostic imaging
  • Cerebral Angiography
  • Coronary Angiography
  • Feasibility Studies
  • Female
  • France
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / instrumentation
  • Heart Valve Prosthesis Implantation / methods*
  • Heart Valve Prosthesis Implantation / mortality
  • Humans
  • Ischemic Attack, Transient / etiology
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Predictive Value of Tests
  • Prospective Studies
  • Registries
  • Risk Factors
  • Stroke / etiology
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Doppler
  • Ultrasonography, Doppler, Transcranial