Comparative Outcomes of Transcarotid and Trans-subclavian Transcatheter Aortic Valve Replacement

Abstract Background Previous reports described successful use of transcarotid and trans-subclavian approaches for the performance of transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis who cannot be treated with transfemoral access. The purpose of the present study was to compare these two alternative approaches with respect to safety, efficacy and procedural efficiency. Methods Retrospective analysis of all TAVR procedures performed via either a transcarotid or a trans-subclavian approach at a single tertiary care medical center between January 2016 to October 2018 was performed. Outcomes are reported in accordance with the Valve Academic Research Consortium definitions. Results 33 and 38 patients had transcarotid TAVR and trans-subclavian TAVR, respectively, during the study period. Transcarotid patients were older (mean age, 82.9±7.2 vs. 78.1±8.2; p=0.012), but otherwise the 2 groups were not significantly different with respect to preoperative characteristics. Valve deployment was similar between the groups (100% vs. 97%; p=0.348). Procedure time was shorter with the transcarotid approach (minutes, 110±32 vs. 134±45; p=0.014). There was a lower mean fluoroscopy air kerma in the transcarotid group (mGy, 682.82±713.48 vs. 2,141±2,055; p Conclusions The transcarotid and the trans-subclavian approaches have similar safety and efficacy outcomes. The transcarotid approach had a shorter procedure duration and a trend towards lower fluoroscopy duration and radiation exposure.