Comparable Outcomes for Transcarotid and Transfemoral Transcatheter Aortic Valve Replacement at a High Volume US Center.
Semin Thorac Cardiovasc Surg
; 34(2): 467-474, 2022.
Article
em En
| MEDLINE
| ID: mdl-33713830
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 United States 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 (TFâ¯=â¯2.0%, TCâ¯=â¯2.7%, P = 0.536) and mortality (TFâ¯=â¯2.1%, TCâ¯=â¯2.7%, Pâ¯=â¯0.629) were similar between groups. PSW 30-day stroke (odds ratio (OR) (95% confidence interval (CI))â¯=â¯0.8 (0.2-2.8)) and mortality (OR (95% CI)â¯=â¯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 Pâ¯=â¯0.28, PSW hazard ratioâ¯=â¯1.0 (0.6-1.7)). Transcarotid TAVR is associated with similar outcomes compared to transfemoral TAVR at an experienced, high-volume center.Palavras-chave
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MEDLINE
Assunto principal:
Estenose da Valva Aórtica
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Acidente Vascular Cerebral
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Substituição da Valva Aórtica Transcateter
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Infarto do Miocárdio
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article