Transcarotid transcatheter aortic valve implantation: A systematic review

• Published in: Journal of cardiology 2018-06, Vol.71 (6), p.525-533
• Main Authors: Wee, Ian Jun Yan, Stonier, Thomas, Harrison, Michael, Choong, Andrew M.T.L.
• Format: Article
• Language: English
• Subjects: Aortic valve replacement; Carotid access; Carotid Arteries - surgery; Humans; Transcarotid; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2018.01.010

•Transcarotid transcatheter aortic valve implantation (TAVI) yields low 30-day mortality and neurological complication rates.•Transcarotid TAVI yields low access site-related complications.•Carotid access could potentially be a first-line alternative for TAVI.•Randomized controlled trials are needed to substantiate the conclusion. The carotid artery is a novel access route for transcatheter aortic valve implantation (TAVI), especially useful in patients unsuitable for traditional access routes including transfemoral (TF), subclavian, transapical (TAp), and aortic (TAo). This systematic review summarizes the evidence on TAVI via the carotid artery for its efficacy and safety. A systematic review was conducted as per the Preferred Reporting Instructions for Systematic Reviews and Meta-analysis (PRISMA) guidelines on three online databases: Medline (via Pubmed), SCOPUS, and Cochrane Database. There were 8 non-randomized controlled trials identified comprising 650 patients in four TAVI vascular access sites: transcarotid (TC) (N=364), TF (N=100), TAp (N=151), TAo (N=35). The 30-day rates of mortality and neurological complications for TC TAVI were 6.5% and 3.8%, respectively, with 1 incidence of myocardial infarction. Other complications included vascular complications (7.7%), insertion of new pacemaker (17.4%), atrial fibrillation (5.2%), and acute kidney injury (6.9%), bleeding episodes (14.3%), of which 13 (3.6%) cases were life-threatening; 5 (1.4%) were major; and 35 (9.3%) were minor cases. Follow-up to 1 year showed 19 further deaths. There were no significant differences in terms of mortality rates [risk ratio (RR)=0.31, 95%CI 0.05–1.79; p=0.19] and onset of dialysis treatment (RR=2.53, 95%CI 0.31–19.78; p=0.38) between the TC and TAp groups. The available data on TC TAVI show comparable technical feasibility with other traditional access routes, representing a viable alternative. However, the paucity of data warrants the need for larger randomized controlled trials to establish a firm conclusion.