Feasibility And Safety Of Transcarotid Transcatheter Aortic Valve Implantation: Data From Multicenter Polish Registry
Radoslaw Wilimski1, Zenon Huczek2, Kajetan Grodecki2, Janusz Kochman2, Bartosz Rymuza2, Wojciech Wojakowski3, Damian Hudziak4, Dariusz Jagielak5, Jerzy Sacha6, Marek Grygier7, Andrzej Walczak8, Piotr Hendzel1, Romuald Cichon1, Krzysztof J. Filipiak2, Grzegorz Opolski2.
1Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland, 21st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland, 3Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland, 4Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland, 5Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland, 6Department of Cardiology, University Hospital, Faculty of Natural Sciences and Technology, University of Opole, Opole, Poland, 71st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland, 8Department of Cardiac Surgery, Medical University of Lodz, Lodz, Poland.
BACKGROUND: To investigate feasibility and safety of transcarotid (TC) access for transcatheter aortic valve implantation (TAVI) in comparison to transfemoral (TF) approach in multicentre setting.
METHODS: A total of 41 patients, treated between December 2014 and January 2018, were retrospectively reported to the Polish Registry of Common Carotid Artery Access for TAVI (POL-CAROTID). The median follow-up time was 619 (365 - 944) days and Valve Academic Research Consortium-2 (VARC-2) definitions were applied. Clinical outcomes were compared with 41 propensity matched TF-TAVI patients.
RESULTS: The mean patients age was 78.0 ± 7.2 years and 29 patients (70.7%) were men. Prohibitive iliofemoral anatomy and/or obesity (46.3%) and/or presence of stent graft in abdominal aorta (31.7%) were the most common indications for TC-TAVI. Device success for TC-TAVI was comparable with matched TF-TAVI group (90.2% vs 95.3%, P=0.396) and no periprocedural mortality was observed. Moreover, early safety was similar between two groups (92.7% vs 95.3%, respectively, log-rank P= 0.658) with only 1 case of non-disabling stroke during the first month after TC-TAVI. Consequently, no cerebrovascular events were observed in the long-term and clinical efficacy of TC-TAVI corresponded well with TF-TAVI (90.2% vs 92.7%, log-rank P=0.716). Total of 4 (9.8%) deaths were noted in TC-TAVI cohort in comparison to 3 (7.3%) in TF-TAVI group.
CONCLUSIONS: TC-TAVI achieves similar safety, efficacy, and functional improvement as TF-TAVI. TC access may be considered as optimal alternative for patients, in whom TF approach is precluded.
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