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

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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