Kardiol Pol. 2021 Jan 25;79(1):31-38. doi: 10.33963/KP.15697. Epub 2020 Dec 3.
Transfemoral access is the preferred approach for transcatheter aortic valve implantation (TAVI), as it is characterized by the lowest complication rate. In the majority of patients ineligible for transfemoral access, the transcarotid approach can be used.
This study aimed to compare short‑term outcomes in 2 groups of patients treated with transcarotid or transfemoral TAVI.
A retrospective comparison included 265 patients in whom the TAVI procedure was performed between 2017 and 2019 (transcarotid TAVI, n = 33; transfemoral TAVI, n = 232). Preoperative characteristics, procedural and postprocedural outcomes, as well as 30‑day mortality were assessed.
Compared with the transfemoral TAVI group,patients undergoing transcarotid TAVI presented with a higher New York Heart Association (NYHA) functional class (median [interquartile range (IQR)], 3 [3-3] vs 2 [2-3]; P <0.001), a higher surgical risk (median [IQR] EuroSCORE II, 6 [4.8-10.7] vs 4.8 [2.8-7.9]; P = 0.003), and a higher incidence of peripheral artery disease (36.4% vs 18.1%; P = 0.035). The median (IQR) procedure duration in the transcarotid TAVI group was shorter than in patients undergoing transfemoral TAVI (65 [60-80] min vs 90 [80-110] min; P <0.001, respectively). In both study groups, we noted a high percentage of procedural success (transcarotid vs transfemoral TAVI, 96.9% vs 97.2%; P = 0.66). We found no significant differences between transcarotid TAVI and transfemoral TAVI in terms of periprocedural and 30‑day mortality as well as the number of strokes. Regardless of the access route chosen, echocardiographic parameters and the NYHA class similarly improved compared with preprocedural data.
Despite posing a higher baseline risk and presenting a greater anatomic complexity, transcarotid access is safe and associated with 30‑day outcomes similar to those observed for transfemoral access. Importantly, procedural time was short and no periprocedural strokes or vascular complications were reported.
经股动脉入路是经导管主动脉瓣植入术（TAVI）的首选入路，因为它具有最低的并发症发生率。在大多数不适合经股动脉入路的患者中，可以使用经颈动脉入路。
本研究旨在比较经颈动脉和经股动脉 TAVI 治疗的两组患者的短期结果。
回顾性比较了 2017 年至 2019 年间接受 TAVI 治疗的 265 名患者（经颈动脉 TAVI 组，n=33；经股动脉 TAVI 组，n=232）。评估了术前特征、手术过程和术后结果以及 30 天死亡率。
与经股动脉 TAVI 组相比，经颈动脉 TAVI 组患者的纽约心脏协会（NYHA）心功能分级更高（中位数[四分位数间距（IQR）]，3[3-3] vs. 2[2-3]；P<0.001），手术风险更高（中位数[IQR]EuroSCORE II，6[4.8-10.7] vs. 4.8[2.8-7.9]；P=0.003），外周动脉疾病发生率更高（36.4% vs. 18.1%；P=0.035）。经颈动脉 TAVI 组的手术时间中位数（IQR）短于经股动脉 TAVI 组（65[60-80]min vs. 90[80-110]min；P<0.001）。在这两个研究组中，我们都观察到了高比例的手术成功率（经颈动脉 TAVI 与经股动脉 TAVI 分别为 96.9%和 97.2%；P=0.66）。在围手术期和 30 天死亡率以及卒中数量方面，经颈动脉 TAVI 与经股动脉 TAVI 之间无显著差异。无论选择哪种入路，与术前数据相比，超声心动图参数和 NYHA 分级均有相似程度的改善。
尽管经颈动脉入路基线风险较高，解剖结构较复杂，但安全可行，与经股动脉入路相比，30 天结果相似。重要的是，手术时间短，无围手术期卒中或血管并发症报告。
