Transcarotid Versus Transapical and Transaortic Access for Transcatheter Aortic Valve Replacement

Abstract Background Transcatheter aortic valve replacement (TAVR) using transcarotid access may improve outcomes compared to transapical or transaortic access. Methods We retrospectively evaluated 165 patients undergoing alternate access TAVR using transcarotid (n=84), transapical (n=48) and transaortic (n=33) access. 30-day outcomes and 2-year Kaplan-Meier survival was analyzed using a multivariable cox proportional hazards model. Results Median Society of Thoracic Surgeons predicted risk of mortality was similar among patients treated by transcarotid, transapical, and transaortic access [9.0% (interquartile range 6.6, 12.0) vs 9.1% (interquartile range 7.0, 11.7) vs 10.0% (interquartile range 8.5, 13.0); p=0.14], respectively. Patients treated with transcarotid TAVR had a trend toward lower 30-day mortality [3.6% (3/84) vs 6.3% (3/48) vs 15.2% (5/33); p=0.09] and significantly better 2-year survival (88.4% vs 79.2% vs 63.6%; p=0.004), compared to patients treated by transapical and transaortic access, respectively. In addition, transcarotid access was associated with a shorter median length of stay [3.0 days (interquartile range 2.0, 5.0) vs 6.5 days (interquartile range 5.0, 9.5) vs 7.0 days (interquartile range 5.0, 9.0); p= Conclusions Transcarotid compared to transapical and transaortic access for TAVR is associated with shorter length of stay, fewer transfusions, more frequent discharge to home and better 2-year survival.