TCT-891 Transcarotid Versus Transcaval Access for Transcatheter Aortic Valve Replacement Using a Balloon Expandable Valve: Propensity-Matched Analysis From a Real-World Registry

Document Type

Conference Proceeding

Publication Date

10-29-2024

Publication Title

J Am Coll Cardiol

Keywords

aged, balloon, bleeding, blood transfusion, cerebrovascular accident, cohort analysis, comorbidity, complication, conference abstract, female, fluoroscopy, general anesthesia, hospital readmission, human, intensive care unit, major clinical study, male, mortality, percutaneous aortic valve, propensity score, transcatheter aortic valve implantation, valvular heart disease

Abstract

Background: Transcarotid and transcaval access for transcatheter aortic valve replacement (TAVR) have demonstrated superior outcomes to transaxillary/transthoracic access; however, comparisons of transcarotid vs transcaval alternate access are lacking. Methods: The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry was queried for patients undergoing transcarotid and transcaval TAVR with the SAPIEN 3 (Edwards Lifesciences) valve platform between November 2018 and September 2023. Procedural, in-hospital, 30-day, and 1-year outcomes, including CMS linkage, were evaluated and then compared using 3:1 propensity score matching. Results: The study included 5,712 patients (transcarotid 5,297; transcaval 415) with a well-matched propensity matched cohort of 1,218 transcarotid and 406 transcaval patients. Overall, this high-risk cohort of patients had a high burden of comorbidities. Transcarotid and transcaval patients had similar mortality at 30 days (4.1% vs 5.5%; P = 0.25) and 1-year (19.4% vs 19.2%; P = 0.87) and similar stroke rates at 30-days (5.6% vs 3.8%; P = 0.15) and 1 year (7.8% vs 5.6%; P = 0.13). Transcarotid access was performed more frequently with general anesthesia (94.9% vs 60.1%; P < 0.0001), admitted to the ICU more often (79.7% vs 66.2%; P = 0.002) and had longer mean ICU times (36.2 h vs 26.7 h; P = 0.03). Procedure time (88.0 vs 119.0 min; P < 0.0001), fluoroscopy time (15.8 vs 36.2 min; P < 0.0001), contrast volume (75.8 mL vs 128.9 mL; P < 0.0001), life-threatening bleeding (1.6% vs 3.9%; P = 0.006) and need for blood transfusion (12.2% vs 20.7%; P < 0.0001) were lower with transcarotid access. Most patients in both groups were discharged home after TAVR (>85%) with a similar median LOS of 2.0 days. Transcarotid access was associated with a lower 30-day rate of new PPM/ICD (7.3% vs 10.9%; P = 0.04) and 30-day readmission rate (11.0% vs 14.9%; P = 0.03). Conclusion: Transcarotid and transcaval access for TAVR with the SAPIEN 3 family valves is associated with similar 30-day and 1-year mortality and stroke. Depending on patient anatomy and Heart Team expertise, both are appropriate and the preferred approaches when TAVR requires nonfemoral access. Categories: STRUCTURAL: Valvular Disease: Aortic.

Volume

84

Issue

18

First Page

B375

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