International Society for Minimally Invasive Cardiothoracic Surgery

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2024 Annual Meeting
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Transcarotid Vs Transfemoral Tavr: A Propensity Matched Analysis
Antonio D'Errico Ramirez1, Sebastien Duval2, Salvatore Muccio1, Laurent Faroux3, Vito Giovanni Ruggieri1;
1Thoracic and Cardiovascular Surgery Unit Robert Debré University Hospital, Reims, France, 2Cardiology Unit, Polyclinique Bezannes, Reims, France, 3Cardiology Unit, Robert Debré University Hospital, Reims, France

BACKGROUND: Patients with contraindications to transfemoral TAVR (5-15%) may benefit from alternative approaches such as transaxillary, transcarotid, trans aortic, transapical access. Still, there is no robust evidence supporting their safety and effectiveness. METHODS: In our study we propose a propensity match analysis between transfemoral and transcarotid TAVR (868 patients) done at CHU of Reims from January 2017 to September 2023.Statistical analyses were performed using R 3.6.0. RESULTS: Propensity score matching provided 135 matched pairs with comparable operative risk (mean EuroSCORE II, TC-TAVR 6,4% vs TF-TAVR 4,8%, P 0.37). Peripheral artery disease was numerically greater in. TC TAVR (73,9 % vs 24,0% P 0.58). Thirty-day (3.7% vs 1.5%, P = 0.447), 1-year mortality (6.2% vs 5.9%, P = 0.807) and 2-year mortality (6.2% vs 7.5%, P = 0.851) after TC-TAVR were comparable with TF-TAVR. No transient ischemic attack was observed in this series. Stroke (n = 4) was numerically more frequent after TC-TAVR compared with TF-TAVR (3.0% vs 0,7%, P = 0.370), but the difference did not reach statistical significance. Among patients undergoing TC-TAVR four patients suffered contro-lateral stroke, 2 of whom treated with mechanical thrombectomy.TF-TAVR was associated with a numerically greater risk of permanent pacemaker implantation (16.3% vs 14.1%, P 0.735) compared with TC-TAVR. Other complications were not frequent and were similarly distributed between the matched groups. CONCLUSIONS: This institutional series represents one of the largest monocentric propensity-matched analysis about TC/TF TAVR. It demonstrated that TC-TAVR is a safe and effective procedure when compared with TF- TAVR. TC access allows a less invasive and direct access to the aortic valve under local anesthesia. TC-TAVR should be considered a valid and safe alternative to TF-TAVR when the femoral access is contraindicated.

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