Author + information
- Keith B. Allena,b,
- Adnan Chhatriwallaa,b,
- David Cohena,b,
- Zuhair Hawaa,b,
- Sanjeev Aggarwala,b,
- Suzanne Barona,b,
- Anthony Harta,b,
- James Mitchella,b,
- Zafir Hawaa,b,
- John Davisa,b and
- A. Michael Borkona,b
Background: TAVR using transcarotid (TC) access in patients with contraindications to TF TAVR may result in improved outcomes.
Methods: Between Feb 2015 and May 2016, 261 patients underwent TAVR; TC access was used preferentially in all patients with contraindications to TF TAVR. Vascular access was TF in 84% (219/261); among non-femoral access, TC access was utilized in 88%(37/42) and is the focus of this study. In-hospital outcomes are reported using the TVT risk calculator. Surgical technique for TC access is illustrated in Figure 1.
Results: TC TAVR patients had a median age of 81 (range 62-92) with a median TVT predicted in-hospital TAVR mortality of 9.1% (range 3-21); observed mortality was 2.7% (1/37) with an observed/expected mortality ratio of 0.3. Both right (17) and left (20) carotid access was utilized for delivery of balloon-expandable (n=35) or self-expanding (n=2) transcatheter aortic valves. Procedural success was 100%. Stroke occurred in 2.7% (1/37). Median LOS was 3 days (range 1-9) and 92% (34/37) of patients were discharged to home. With a mean follow up of 6 months (range 1-16 months), survival was 94.6% (87.6%, 100%) with no late carotid access complications or strokes (Fig 1F).
Conclusions: Transcarotid TAVR is safe and may be preferable to more invasive, historically utilized alternative access TAVR options when compared to the TVT non-femoral TAVR risk calculator, which currently reflects mortality risk associated primarily with transapical and transaortic access.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Vascular Access and Hemostasis Issues
Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications
Presentation Number: 1192-124
- 2017 American College of Cardiology Foundation