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Comparable Outcomes for Transcarotid and Transfemoral Transcatheter Aortic Valve Replacement at a High Volume US Center.
Seminars in thoracic and cardiovascular surgery
  • Brandon Jones, Providence St. Joseph Health, CARDS
  • V Kumar, Providence St. Joseph Health, CARDS
  • Shih-Ting Chiu, Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St Joseph Health, Portland, Oregon
  • Ethan C Korngold, Providence Heart and Vascular Institute, Providence Health & Services, Portland, Oregon
  • Robert W. Hodson, Providence Valve Center, St. Vincent Medical Center, Portland, Oregon, USA
  • Kateri Spinelli, Providence St. Joseph Health, CARDS
  • Eric B Kirker, Providence Heart and Vascular Institute, Providence Health & Services, Portland, Oregon
Document Type
Article
Publication Date
3-10-2021
Keywords
  • oregon,
  • portland,
  • cards,
  • cards publication
Disciplines
Abstract

With continued growth of transcatheter aortic valve replacement (TAVR), safe alternative access remains important for patients without adequate transfemoral (TF) access. Registry-based outcomes with transcarotid (TC) TAVR are favorable compared to transapical or transaxillary/subclavian, but TC vs TF comparisons have not been made. Our objective was to compare outcomes between TF and TC access routes for TAVR at a high-volume US center. Methods: We retrospectively evaluated all TF and TC TAVR procedures from June 11, 2014 (first TC case) through December 31, 2019. The primary outcomes were 30-day stroke and 30-day mortality. Secondary outcomes were 1-year stroke, 1-year survival, and 30-day and 1-year life-threatening/major bleeding, vascular complications, and myocardial infarction. Propensity score weighted (PSW) models were used to compare risk-adjusted TF and TC outcomes. Of 1,465 TAVR procedures, 1319 (90%) were TF and 146 (10%) were TC. Procedure time and length of stay did not differ between groups. Unadjusted 30-day stroke (TF=2.0%, TC=2.7%, p=0.536) and mortality (TF=2.1%, TC=2.7%, p=0.629) were similar between groups. PSW 30-day stroke (odds ratio (OR) (95% confidence interval (CI)) = 0.8 (0.2-2.8)) and mortality (OR (95% CI) = 0.8 (0.2-3.0)) were similar between groups. Unadjusted and PSW 30-day major/life threatening bleeding, major vascular complications, and myocardial infarction did not differ between groups. Survival at one year was 90% (88%-92%) for TF patients and 87% (81%-93%) for TC patients (unadjusted p=0.28, PSW hazard ratio = 1.0 (0.6-1.7)). Transcarotid TAVR is associated with similar outcomes compared to transfemoral TAVR at an experienced, high-volume center.

Clinical Institute
Cardiovascular (Heart)
Specialty
Cardiology
Citation Information
Brandon Jones, V Kumar, Shih-Ting Chiu, Ethan C Korngold, et al.. "Comparable Outcomes for Transcarotid and Transfemoral Transcatheter Aortic Valve Replacement at a High Volume US Center." Seminars in thoracic and cardiovascular surgery (2021)
Available at: http://works.bepress.com/kateri-spinelli/57/