In the Journals

TAVR with transcarotid approach safe in patients with severe aortic stenosis

Michael J. Reardon
Michael J. Reardon

The use of a transcatheter heart valve in patients who underwent transcatheter aortic valve replacement with the transcarotid approach was safe and effective, according to a study published in JACC: Cardiovascular Interventions.

“The transcarotid approach could be considered as a safe alternative approach for TAVR when the transfemoral access is prohibited,” Pavel Overtchouk, MD, of Lille University Hospital in France, and colleagues wrote.

French Transcarotid TAVR registry

Researchers analyzed data from 314 patients (median age, 83 years; 63% men) with severe symptomatic aortic stenosis from the French Transcarotid TAVR registry between 2014 and April 2018. Data included clinical and procedural characteristics and outcomes in addition to patient demographics. Patients underwent the procedure with a transcatheter heart valve (Sapien 3, Edwards Lifesciences) through the transcarotid approach.

Clinical endpoints of interest included procedural success, which was defined as successful implantation of a single transcatheter heart valve in the proper aortic position without aortic rupture. Cerebrovascular events were also recorded. Follow-up was conducted for a median of 30 days.

Patients in this study had intermediate to high surgical risk with a Society of Thoracic Surgeons mortality risk score of 5.8%. Peripheral artery disease was seen in 64% of patients, according to the researchers.

Most patients underwent transcarotid TAVR under general anesthesia (91%) and through the left carotid artery (73.6%). Procedural success was seen in 97% of patients.

Outcomes related to TAVR

Annulus ruptures occurred in three patients, of whom two died during the procedure and one died on day 3, the researchers wrote.

The rate of major bleeding was 4.1% at 30 days. In addition, the rate of new permanent pacemaker implantation was 16%, and stroke or transient ischemic attack occurred in 1.6% of patients. During follow-up, 3.2% of patients died.

“Further research is warranted to provide direct comparative evaluation of the transcarotid approach to the transfemoral as well as other alternative approaches such as trans-subclavian, transapical, transaortic and transaortic,” Overtchouk and colleagues wrote. “Also, data on safety of transcarotid transcatheter aortic valve replacement in low-risk patients and all comers would allow operators to consider this approach regardless of the risk profile.”

Colin Barker
Colin Barker

In a related editorial, Michael J. Reardon, MD, Allison Family Distinguished Chair of Cardiovascular Research in the department of cardiovascular surgery, professor of cardiovascular surgery at the Institute for Academic Medicine and full member of the Research Institute at Houston Methodist Hospital, and Colin Barker, MD, FACC, FSCAI, assistant professor of cardiology at the Institute for Academic Medicine and assistant clinical member of the Research Institute at Houston Methodist Hospital, wrote: “This group led by Dr. Modine has gone a long way to showing us that transcarotid access does not have the feared neurological consequences and may well also be equivalent to subclavian and [transfemoral] access. In addition, the exposure of the carotid artery is even technically simpler ... than exposing the axillary artery with its close relationship to the brachial plexus. Either is easier for an experienced cardiovascular surgeon to expose.” – by Darlene Dobkowski

Disclosures: The study was funded by Edwards Lifesciences. Overtchouk, Reardon and Barker report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures

Michael J. Reardon
Michael J. Reardon

The use of a transcatheter heart valve in patients who underwent transcatheter aortic valve replacement with the transcarotid approach was safe and effective, according to a study published in JACC: Cardiovascular Interventions.

“The transcarotid approach could be considered as a safe alternative approach for TAVR when the transfemoral access is prohibited,” Pavel Overtchouk, MD, of Lille University Hospital in France, and colleagues wrote.

French Transcarotid TAVR registry

Researchers analyzed data from 314 patients (median age, 83 years; 63% men) with severe symptomatic aortic stenosis from the French Transcarotid TAVR registry between 2014 and April 2018. Data included clinical and procedural characteristics and outcomes in addition to patient demographics. Patients underwent the procedure with a transcatheter heart valve (Sapien 3, Edwards Lifesciences) through the transcarotid approach.

Clinical endpoints of interest included procedural success, which was defined as successful implantation of a single transcatheter heart valve in the proper aortic position without aortic rupture. Cerebrovascular events were also recorded. Follow-up was conducted for a median of 30 days.

Patients in this study had intermediate to high surgical risk with a Society of Thoracic Surgeons mortality risk score of 5.8%. Peripheral artery disease was seen in 64% of patients, according to the researchers.

Most patients underwent transcarotid TAVR under general anesthesia (91%) and through the left carotid artery (73.6%). Procedural success was seen in 97% of patients.

Outcomes related to TAVR

Annulus ruptures occurred in three patients, of whom two died during the procedure and one died on day 3, the researchers wrote.

The rate of major bleeding was 4.1% at 30 days. In addition, the rate of new permanent pacemaker implantation was 16%, and stroke or transient ischemic attack occurred in 1.6% of patients. During follow-up, 3.2% of patients died.

“Further research is warranted to provide direct comparative evaluation of the transcarotid approach to the transfemoral as well as other alternative approaches such as trans-subclavian, transapical, transaortic and transaortic,” Overtchouk and colleagues wrote. “Also, data on safety of transcarotid transcatheter aortic valve replacement in low-risk patients and all comers would allow operators to consider this approach regardless of the risk profile.”

Colin Barker
Colin Barker

In a related editorial, Michael J. Reardon, MD, Allison Family Distinguished Chair of Cardiovascular Research in the department of cardiovascular surgery, professor of cardiovascular surgery at the Institute for Academic Medicine and full member of the Research Institute at Houston Methodist Hospital, and Colin Barker, MD, FACC, FSCAI, assistant professor of cardiology at the Institute for Academic Medicine and assistant clinical member of the Research Institute at Houston Methodist Hospital, wrote: “This group led by Dr. Modine has gone a long way to showing us that transcarotid access does not have the feared neurological consequences and may well also be equivalent to subclavian and [transfemoral] access. In addition, the exposure of the carotid artery is even technically simpler ... than exposing the axillary artery with its close relationship to the brachial plexus. Either is easier for an experienced cardiovascular surgeon to expose.” – by Darlene Dobkowski

Disclosures: The study was funded by Edwards Lifesciences. Overtchouk, Reardon and Barker report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures