Transfemoral Versus Transcarotid Transcatheter Aortic Valve Replacement Under Locoregional Anesthesia: A Propensity-Matched Single-Center Analysis of 868 Patients.

OBJECTIVES

To evaluate the safety and efficacy of transcarotid transcatheter aortic valve replacement (TC-TAVR) performed under locoregional anesthesia compared with the standard transfemoral (TF) approach (transfemoral transcatheter aortic valve replacement [TF-TAVR]), with a particular focus on neurologic outcomes and validation of transcarotid (TC) access as a viable alternative access route.

DESIGN

A retrospective, single-center, observational cohort study with propensity score matching.

SETTING

A tertiary care academic institution with a high-volume structural heart disease program: Reims University Hospital, France.

PARTICIPANTS

A total of 868 patients who underwent transcatheter aortic valve replacement between January 2017 and September 2023 were included. Of these, 707 underwent TF-TAVR and 161 underwent TC-TAVR. After 1:1 propensity score matching, 135 matched pairs were analyzed.

INTERVENTIONS: All procedures were performed under local or locoregional anesthesia with conscious sedation. TC access was achieved via surgical cervicotomy and temporary carotid clamping; TF access was performed percutaneously. Neurologic monitoring was routinely applied in TC-TAVR cases.

MEASUREMENTS AND MAIN

RESULTS

Primary endpoints included 30-day, 1-year, and 2-year all-cause mortality, as well as stroke or transient ischemic attack (TIA). After matching, early mortality and mid-term mortality were comparable between groups (30 days: 1.5% in TC group v 3.7% in TF group, p = 0.447; 2 years: 5.9% in TC group v 7.4% in TF group, p = 0.807). Stroke occurred more frequently in the TC group (3.7% v 0.7%), but this was not statistically significant (p = 0.214). No TIAs were observed. Secondary complications, including vascular and pacemaker implantation rates, were similarly distributed.

CONCLUSIONS

TC-TAVR under locoregional anesthesia is a safe and effective alternative to TF-TAVR, with comparable mortality and neurologic outcomes. It should be considered a valid access route in patients with contraindications to TF access.