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Can Transcarotid Tavr Achieve Outcomes As Good As Transfemoral Tavr For High Risk Patients Who Need Alternative Access
Mohiuddin Cheema, Raymond Mckay, David Underhill, Hossein Ouranos.
Hartford Hospital, Hartford, CT, USA.

OBJECTIVE:
Can TransCarotid TAVR achieve outcomes as good as TransFemoral TAVR for high risk patients who need alternative access
METHODS:
A retrospective analysis of consecutive TransCarotid (TC) and TransFemoral (TF) TAVR procedures performed at a single tertiary care medical center between 2016 and 2020. All outcomes are reported in accordance with the Valve Academic Research Consortium definitions.
RESULTS:
In the study period, a total of 1894 patients were included: 92 patients received TC TAVR and 1802 received TF TAVR. STS risk score was higher in TC group (79% high or extreme risk vs 62% in TF Group). Lot more patients in TC group had prior MI ( 32% vs 21%), Prior CABG (29% vs 16%), moderate to severe COPD (58% vs 27%), PAD (60% vs 18%), bilateral carotid stenosis (26% vs 7%) Anesth: GA 98% TC group vs 26% in TF Group. OR time (hrs) trended equal TC vs TF cases, 2.11.3 vs 1.90.9 p = 0.053 and there was a significant difference in Fluoro dose (Kerm) 641.50 vs 1019, p <0.004 but not in Fluoro time(min) 21.048.5 vs 21.3214.3 p <0.85 for TC vs TF respectively. There were no differences in bleeding events (TC 3% vs TF3%, p=0.3), Perioperative Stroke events (TC 4% vs TF 2%, p=0.20), Major Vascular complications (TC 0% vs TF 2%, p=0.18), Unplanned Cardiac Surgery Procedures (TC 3% vs TF 2% p= 0.7), PPM (TC 10% vs TF 15%, p=0.17. There were no differences in mortality (TC 0.0% vs TF 2% p=0.22), ICU stay and hospital LOS (TC 3.6 days vs TF 3.3 days p=0.4).
CONCLUSIONS:
Transcarotid approach to TAVR is safe and able to achieve outcomes comparable to Transfemoral approach even in high risk patients. This needs to be further validated with randomized controlled trials comparing TF to TC approach.


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