Transcatheter Aortic Valve Replacement: Comparing Transfemoral, Transcarotid, and Transcaval Access

The Annals of Thoracic Surgery
Gaetano PaoneAdam B Greenbaum

Abstract

Despite newer-generation valves using smaller-sized sheaths, 10% to 20% of patients undergoing transcatheter aortic valve replacement (TAVR) require nonfemoral artery access for valve delivery. To avoid a transthoracic procedure, we have used transcarotid (TC) and transcaval (TCav) approaches in these patients. This study compared the results of a contemporary experience with transfemoral (TF), TC, and TCav approaches. Between January 2015 and March 2017, 491 patients underwent TAVR at our institution, of which 463 were included in this analysis. Valve delivery was TF in 373 patients, TCav in 58, and TC in 32. Patient characteristics and outcomes, including 1-year survival, were compared. Preoperative demographics and postoperative outcomes were similar for the three groups with several exceptions. TCav patients had higher The Society of Thoracic Surgeons risk score than TF patients (8.0 ± 5.2 vs 6.1 ± 4.3, p = 0.004). Lung disease, cerebrovascular disease, and peripheral vascular disease were more common in TC and TCav patients. Median length of stay was 2 days for TF, 3 days for TC, and 4 days for TCav (TF vs TCav, p = 0.001). Procedural mortality, percentage discharged home, and the 30-day readmission rate were similar for a...Continue Reading

Citations

Sep 6, 2020·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Sharan Prakash SharmaAshok Kondur
Jul 16, 2019·The Journal of Cardiovascular Surgery·Hisato TakagiUNKNOWN ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
Nov 2, 2019·Current Cardiology Reports·Marvin H EngWilliam W O'Neill
Dec 29, 2019·Cardiovascular Revascularization Medicine : Including Molecular Interventions·Tamunoinemi Bob-ManuelUzoma N Ibebuogu
Mar 16, 2021·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Marvin H Eng, H Kenith Fang
Feb 20, 2019·The American Journal of Cardiology·Mathurin BeveJean-Philippe Verhoye
May 13, 2021·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Daniel P McGrathYong Zhan
Apr 22, 2020·The Journal of Thoracic and Cardiovascular Surgery·Gaetano Paone, Kendra J Grubb

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