AUTHOR=Lu Henri , Monney Pierre , Hullin Roger , Fournier Stephane , Roguelov Christian , Eeckhout Eric , Rubimbura Vladimir , Faroux Laurent , Barrier Adelin , Muller Olivier , Kirsch Matthias 

TITLE=Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.687168

DOI=10.3389/fcvm.2021.687168

ISSN=2297-055X

ABSTRACT=Background
The transfemoral (TF) route is the gold-standard access for transcatheter aortic valve replacement (TAVR). In 10-15% of patients, alternative accesses are needed, such as the transcarotid (TC) access. We performed a meta-analysis to compare 30-day mortality and complications between TC-TAVR and TF-TAVR.

Methods
We searched PubMed/MEDLINE and EMBASE from inception to January 2021 to identify articles comparing TC-TAVR and TF-TAVR. Patients’ baseline characteristics, procedural outcomes, and clinical 30-day outcomes were extracted.

Results
We identified 9 studies, among which 2 used propensity-score matching, including 1374 TC patients and 3706 TF patients. TC-TAVR was associated with significantly higher EuroSCORE II and Logistic EuroSCORE values (respectively 8.0±6.7 vs. 6.3±5.4, p=0.002 and 20.8±14.2% vs. 20.0±13.4%, p=0.04), a higher prevalence of peripheral artery disease (52.6% vs. 32.8%, p=0.001), previous cardiac surgery (26.3% vs. 22.4%, p=0.008) and coronary artery disease (64.6% vs. 60.5%, p=0.020). The pooled results found TC-TAVR to be associated with a significantly higher 30-day mortality risk (RR, 1.41, 95% CI, 1.02 to 1.96, p=0.040), and a lower rate of 30-day major vascular complications (RR, 0.48, 95% CI, 0.25 to 0.92, p=0.030). No significant difference was found regarding permanent pacemaker implantation, major bleeding and acute kidney injury. A subgroup analysis of the two propensity-score matched studies found a statistically increased risk of 30-day neurovascular complications (RR, 1.61, 95% CI, 1.02 to 2.55, p=0.040). 

Conclusion
Compared with TF-TAVR, TC-TAVR was associated with an increased risk of 30-day mortality, likely related to a higher surgical risk and comorbidity burden, and with an increased risk of 30-day neurovascular complications. Careful preprocedural patient selection and close periprocedural neurological monitoring are paramount.