Transcarotid Transcatheter Aortic Valve Replacement: Feasibility and Safety

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• 作者：Darren Mylotte ; MD^a ; Arnaud Sudre ; MD^b ; Emmanuel Teiger ; MD ; PhD^c ; Jean Franç ; ois Obadia ; MD ; PhD^d ; Marcus Lee ; MD^a ; Mark Spence ; MD^e ; Hazem Khamis ; MD^f ; Arif Al Nooryani ; MD^g ; Cedric Delhaye ; MD^b ; Gilles Amr ; MD^b ; Mohamad Koussa ; MD^b ; Nicolas Debry ; MD^b ; Nicolo Piazza ; MD ; PhD^h ; Thomas Modine ; MD ; PhD^b ; ^{t1modine@yahoo.fr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：aortic stenosis ; carotid vascular access ; transcatheter aortic valve replacement
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：14 March 2016
• 年：2016
• 卷：9
• 期：5
• 页码：472-480
• 全文大小：1034 K

文摘

The purpose of this study was to assess the feasibility and safety of transcarotid transcatheter aortic valve replacement (TAVR).

Background

Many candidates for TAVR have challenging vascular anatomy that precludes transfemoral access. Transcarotid arterial access may be an option for such patients.

Methods

The French Transcarotid TAVR Registry is a voluntary database that prospectively collected patient demographics, procedural characteristics, and clinical outcomes among patients undergoing transcarotid TAVR. Outcomes are reported according to the updated Valve Academic Research Consortium criteria.

Results

Among 96 patients undergoing transcarotid TAVR at 3 French sites (2009 to 2013), the mean age and Society of Thoracic Surgeons predicted risk of mortality were 79.4 ± 9.2 years and 7.1 ± 4.1%, respectively. Successful carotid artery access was achieved in all patients. The Medtronic CoreValve (Medtronic, Inc., Minneapolis, Minnesota) (n = 89; 92.7%) and Edwards SAPIEN valves (Edwards Lifesciences, Irvine, California) (n = 7; 7.3%) were used. Procedural complications included: valve embolization (3.1%), requirement for a second valve (3.1%), and tamponade (4.2%). There were no major bleeds or major vascular complications related to the access site. There were 3 (3.1%) procedural deaths and 6 (6.3%) deaths at 30 days. The 1-year mortality rate was 16.7%. There were 3 (3.1%) cases of Valve Academic Research Consortium–defined in-hospital stroke (n = 0) or transient ischemic attack (TIA) (n = 3). None of these patients achieved the criteria for stroke and none manifested new ischemic lesions on cerebral computed tomography or magnetic resonance imaging. At 30 days, a further 3 TIAs were observed, giving an overall stroke/TIA rate of 6.3%.

Conclusions

Transcarotid vascular access for TAVR is feasible and is associated with encouraging short- and medium-term clinical outcomes. Prospective studies are required to ascertain if transcarotid TAVR yields equivalent results to other nonfemoral vascular access routes.