Tufts University School of Medicine, Boston, Massachusetts, USA.
Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
Catheter Cardiovasc Interv. 2021 Oct;98(4):767-773. doi: 10.1002/ccd.29768. Epub 2021 May 12.
Carotid access has shown promise as an excellent delivery route for transcatheter aortic valve replacement (TAVR). We aimed to compare outcomes of transcarotid (TC) and transfemoral (TF) TAVR by conducting a search and analysis of the best evidence in the literature to shed light on its safety and effectiveness.
The PubMed/MEDLINE, Embase, and Cochrane library from inception to July 2020 were searched to identify articles reporting comparative data on TC versus TF approaches for TAVR. Patients' baseline characteristics and clinical outcomes were extracted from the articles and pooled for analysis.
Five studies, including a total of 2470 patients, were included in the study with 1859 patients in the TF group and 611 patients in the TC group. The TC group had higher prevalence of peripheral vascular disease, while the patients in the TF group was older. Meta-analysis revealed that there was no significant differences between the two groups with regard to 30-day mortality (p = 0.09), stroke (p = 0.28), new dialysis (p = 0.58), major bleeding (p = 0.69), or pacemaker implantation (p = 0.44). The TF group had a higher incidence of vascular complications (3.9% vs. 2.3%; OR 2.22; 95% CI [1.13, 4.38]; p = 0.02).
Compared with the TF approach, TC-TAVR is associated with comparable procedural and clinical outcomes. Our analysis found a lower rate of vascular complication in TC access compared with TF access. This supports consideration of such an alternative access when there are concerns over the feasibility of TF access.
经颈动脉入路(transcarotid, TC)已被证明是经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)的一种优秀的输送途径。我们旨在通过搜索和分析文献中的最佳证据，比较经颈动脉（TC）和经股动脉（transfemoral, TF）TAVR 的结果，以阐明其安全性和有效性。
从建库至 2020 年 7 月，检索 PubMed/MEDLINE、Embase 和 Cochrane 图书馆，以确定报道 TC 与 TF 方法比较 TAVR 的文章。从文章中提取患者的基线特征和临床结果，并进行汇总分析。
共有 5 项研究，包括 2470 例患者，纳入研究。TF 组 1859 例，TC 组 611 例。TC 组外周血管疾病的患病率较高，而 TF 组患者年龄较大。Meta 分析显示，两组在 30 天死亡率（p = 0.09）、卒（p = 0.28）、新透析（p = 0.58）、大出血（p = 0.69）或起搏器植入（p = 0.44）方面无显著差异。TF 组血管并发症发生率较高（3.9%比 2.3%；OR 2.22；95%CI [1.13, 4.38]；p = 0.02）。
与 TF 方法相比，TC-TAVR 与可比较的手术和临床结果相关。我们的分析发现 TC 入路的血管并发症发生率低于 TF 入路。这支持在考虑 TF 入路的可行性时，考虑这种替代入路。
