Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysisCentral MessagePerspective
Transaxillary access has been the most frequently used nonfemoral access route for transcatheter aortic valve replacement (TAVR) with a self-expanding valve. Use of transcarotid TAVR is increasing; however, comparative data on these methods are limited. We compared outcomes following transcarotid or...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-10-01
|
| Series: | JTCVS Techniques |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723002675 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849239413366718464 |
|---|---|
| author | Keith B. Allen, MD Daniel Watson, MD Amit N. Vora, MD Paul Mahoney, MD Adnan K. Chhatriwalla, MD Jonathan G. Schwartz, MD Antoine Keller, MD Nishtha Sodhi, MD Daniel Haugan, MS Michael Caskey, MD |
| author_facet | Keith B. Allen, MD Daniel Watson, MD Amit N. Vora, MD Paul Mahoney, MD Adnan K. Chhatriwalla, MD Jonathan G. Schwartz, MD Antoine Keller, MD Nishtha Sodhi, MD Daniel Haugan, MS Michael Caskey, MD |
| author_sort | Keith B. Allen, MD |
| collection | DOAJ |
| description | Transaxillary access has been the most frequently used nonfemoral access route for transcatheter aortic valve replacement (TAVR) with a self-expanding valve. Use of transcarotid TAVR is increasing; however, comparative data on these methods are limited. We compared outcomes following transcarotid or transaxillary TAVR with a self-expanding, supra-annular valve. Methods: The Transcatheter Valve Therapy Registry was queried for TAVR procedures using transaxillary and transcarotid access between July 2015 and June 2021. Patients received a self-expanding Evolut R, PRO, or PRO + valve (Medtronic) and had 1-year follow-up. Thirty-day and 1-year outcomes were compared in transcarotid and transaxillary groups after 1:2 propensity score-matching. Multivariable regression models were fitted to identify predictors of key end points. Results: The propensity score–matched cohort included 576 patients receiving transcarotid and 1142 receiving transaxillary access. Median procedure time (99 vs 118 minutes; P < .001) and hospital stay (2 vs 3 days; P < .001) were shorter with transcarotid versus transaxillary access. At 30 days, patients with transcarotid access had similar mortality (Kaplan–Meier estimates 3.7% vs 4.3%, P = .57) but significantly lower stroke (3.1% vs 5.9%; P = .017) and mortality or stroke (6.0% vs 8.9%; P = .033) compared with patients receiving transaxillary access. Similar differences were observed at 1 year. Transaxillary access was associated with increased risk of 30-day stroke (hazard ratio, 2.14; 95% confidence interval, 1.27-3.58) by multivariable regression analysis. Conclusions: Transcarotid versus transaxillary access for TAVR using a self-expanding valve is associated with procedural benefits and significantly lower stroke and mortality or stroke at 30 days. In patients with unsuitable femoral anatomy, transcarotid access may be the preferred delivery route for self-expanding valves. |
| format | Article |
| id | doaj-art-e118ebee1b344ee79cc47f4ee79f07a5 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-e118ebee1b344ee79cc47f4ee79f07a52025-08-20T04:01:01ZengElsevierJTCVS Techniques2666-25072023-10-0121455510.1016/j.xjtc.2023.07.019Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysisCentral MessagePerspectiveKeith B. Allen, MD0Daniel Watson, MD1Amit N. Vora, MD2Paul Mahoney, MD3Adnan K. Chhatriwalla, MD4Jonathan G. Schwartz, MD5Antoine Keller, MD6Nishtha Sodhi, MD7Daniel Haugan, MS8Michael Caskey, MD9Department of Cardiovascular/Thoracic Surgery, St Luke’s Mid America Heart Institute, Kansas City, Mo; Address for reprints: Keith B. Allen, MD, Department of Cardiovascular and Thoracic Surgery, St. Luke's Mid America Heart Institute, 4320 Wornall Rd, Medical Plaza II, Suite 50, Kansas City, MO 64111.Department of Cardiovascular/Thoracic Surgery, Riverside Methodist Hospital, Columbus, OhioDepartment of Cardiology, University of Pittsburgh Medical Center Pinnacle Heart and Vascular Institute, Wormleysburg, PaDepartment of Cardiology, Sentara Heart Hospital, Norfolk, VaDepartment of Cardiology, St Luke’s Mid America Heart Institute, Kansas City, MoDepartment of Cardiology, Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NCDepartment of Cardiovascular/Thoracic Surgery, Ochsner Lafayette General Hospital, Lafayette, LaUVA Heart and Vascular Center, Charlottesville, VaMedtronic, Mounds View, MinnDepartment of Cardiovascular/Thoracic Surgery, Abrazo Arizona Heart Hospital, Phoenix, ArizTransaxillary access has been the most frequently used nonfemoral access route for transcatheter aortic valve replacement (TAVR) with a self-expanding valve. Use of transcarotid TAVR is increasing; however, comparative data on these methods are limited. We compared outcomes following transcarotid or transaxillary TAVR with a self-expanding, supra-annular valve. Methods: The Transcatheter Valve Therapy Registry was queried for TAVR procedures using transaxillary and transcarotid access between July 2015 and June 2021. Patients received a self-expanding Evolut R, PRO, or PRO + valve (Medtronic) and had 1-year follow-up. Thirty-day and 1-year outcomes were compared in transcarotid and transaxillary groups after 1:2 propensity score-matching. Multivariable regression models were fitted to identify predictors of key end points. Results: The propensity score–matched cohort included 576 patients receiving transcarotid and 1142 receiving transaxillary access. Median procedure time (99 vs 118 minutes; P < .001) and hospital stay (2 vs 3 days; P < .001) were shorter with transcarotid versus transaxillary access. At 30 days, patients with transcarotid access had similar mortality (Kaplan–Meier estimates 3.7% vs 4.3%, P = .57) but significantly lower stroke (3.1% vs 5.9%; P = .017) and mortality or stroke (6.0% vs 8.9%; P = .033) compared with patients receiving transaxillary access. Similar differences were observed at 1 year. Transaxillary access was associated with increased risk of 30-day stroke (hazard ratio, 2.14; 95% confidence interval, 1.27-3.58) by multivariable regression analysis. Conclusions: Transcarotid versus transaxillary access for TAVR using a self-expanding valve is associated with procedural benefits and significantly lower stroke and mortality or stroke at 30 days. In patients with unsuitable femoral anatomy, transcarotid access may be the preferred delivery route for self-expanding valves.http://www.sciencedirect.com/science/article/pii/S2666250723002675transcarotidtransaxillaryTAVRself-expandingsupra-annularTVT registry |
| spellingShingle | Keith B. Allen, MD Daniel Watson, MD Amit N. Vora, MD Paul Mahoney, MD Adnan K. Chhatriwalla, MD Jonathan G. Schwartz, MD Antoine Keller, MD Nishtha Sodhi, MD Daniel Haugan, MS Michael Caskey, MD Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysisCentral MessagePerspective JTCVS Techniques transcarotid transaxillary TAVR self-expanding supra-annular TVT registry |
| title | Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysisCentral MessagePerspective |
| title_full | Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysisCentral MessagePerspective |
| title_fullStr | Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysisCentral MessagePerspective |
| title_full_unstemmed | Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysisCentral MessagePerspective |
| title_short | Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysisCentral MessagePerspective |
| title_sort | transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self expanding valve a propensity matched analysiscentral messageperspective |
| topic | transcarotid transaxillary TAVR self-expanding supra-annular TVT registry |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723002675 |
| work_keys_str_mv | AT keithballenmd transcarotidversustransaxillaryaccessfortranscatheteraorticvalvereplacementwithaselfexpandingvalveapropensitymatchedanalysiscentralmessageperspective AT danielwatsonmd transcarotidversustransaxillaryaccessfortranscatheteraorticvalvereplacementwithaselfexpandingvalveapropensitymatchedanalysiscentralmessageperspective AT amitnvoramd transcarotidversustransaxillaryaccessfortranscatheteraorticvalvereplacementwithaselfexpandingvalveapropensitymatchedanalysiscentralmessageperspective AT paulmahoneymd transcarotidversustransaxillaryaccessfortranscatheteraorticvalvereplacementwithaselfexpandingvalveapropensitymatchedanalysiscentralmessageperspective AT adnankchhatriwallamd transcarotidversustransaxillaryaccessfortranscatheteraorticvalvereplacementwithaselfexpandingvalveapropensitymatchedanalysiscentralmessageperspective AT jonathangschwartzmd transcarotidversustransaxillaryaccessfortranscatheteraorticvalvereplacementwithaselfexpandingvalveapropensitymatchedanalysiscentralmessageperspective AT antoinekellermd transcarotidversustransaxillaryaccessfortranscatheteraorticvalvereplacementwithaselfexpandingvalveapropensitymatchedanalysiscentralmessageperspective AT nishthasodhimd transcarotidversustransaxillaryaccessfortranscatheteraorticvalvereplacementwithaselfexpandingvalveapropensitymatchedanalysiscentralmessageperspective AT danielhauganms transcarotidversustransaxillaryaccessfortranscatheteraorticvalvereplacementwithaselfexpandingvalveapropensitymatchedanalysiscentralmessageperspective AT michaelcaskeymd transcarotidversustransaxillaryaccessfortranscatheteraorticvalvereplacementwithaselfexpandingvalveapropensitymatchedanalysiscentralmessageperspective |