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

Transcarotid Transcatheter Aortic Valve Replacement: Feasibility and Safety.

Author information

1
University Hospital Galway, Galway, Ireland.
2
Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Lille, France.
3
Hopital Mondor, Paris, France.
4
Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France.
5
Royal Victoria Hospital, Belfast Trust, Queen's University Belfast, Belfast, United Kingdom.
6
Department of Cardiology, October 6 University, Cairo, Egypt.
7
Cardiology Department, Al Qassimi Hospital, Dubai, United Arab Emirates.
8
Department of Interventional Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
9
Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Lille, France. Electronic address: t1modine@yahoo.fr.

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

Comment in

PMID:
26965937
DOI:
10.1016/j.jcin.2015.11.045
[Indexed for MEDLINE]
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