The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Transaxillary compared with transcarotid access for TAVR: a propensity-matched comparison from a French multicenter registry

DOI: 10.4244/EIJ-D-20-00117

1. Heart Team, Institute Cœur-Poumons, CHU Lille, F-59000 Lille, France, FRANCE
2. Heart Team, Hôpital Marie Lannelongue, F-92350 Le Plessis Robinson, France
3. Heart Team, CHU Montpellier, F-34000 Montpellier, France
4. -Heart Team, Institut Cœur-Poumons, CHU Lille, F-59000 Lille, France -National Institute of Health and Medical Research U1011, F-59000 Lille, France
5. Heart Team, CH Lens, F-62300 Lens, France
6. Heart Team, Institut Cœur-Poumons, CHU Lille, F-59000 Lille, France
7. Heart Team, CHU Nîmes, F-30000 Nîmes, France
8. Univ. Lille, CHU Lille, EA 2694-Santé publique:épidémiologie et qualité des soins of biostatistics, EA 2694 – Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France

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Aims:No randomized study comparing the outcomes of transcarotid (TC) and transaxillary (TAx) TAVR has been conducted to date.

Methods and results:From 2010 to 2018, a French multicenter prospective registry included 502 patients with n=374 undergoing TC-TAVR and n=128 TAx-TAVR for symptomatic aortic stenosis. Patients treated through TAx access were matched 1:2 to patients treated through TC route by using propensity score (20 clinical, anatomical and procedural variables) and by date of the procedure. The first outcome was the mortality at 1-month follow-up. The second outcome was 1-month stroke/transient ischemic attack (TIA).In matched-propensity analyses, the incidence of the primary outcome was similar in TAx and TC group (TAx 5.5% vs. TC 4.5%; OR=1.23; 95%CI:0.40-3.70). The secondary outcome was similar in TAx (3.2%) and TC (6.8%; OR=0.52; 95%CI:0.14-1.84). Minor bleeding (2.7% vs. 9.3%; OR=0.26; 95%CI:0.07-0.92) and main access hematoma (3.6% vs. 10.3%; OR=0.034; 95% CI:0.09-0.92) were significantly more frequent with the TC access. One-month clinical efficacy and safety and 1-year mortality did not differed according to different routes.

Conclusions:One-month mortality, 1-month stroke/TIA and 1-year mortality are similar with TAx and TC TAVR. However TC-TAVR is accompanied by more minor bleeding and main access hematoma compared with the transaxillary route.

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