Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
Department of Cardiac and Vascular Surgery Medical University of Gdansk, Poland.
Cardiol J. 2023;30(2):188-195. doi: 10.5603/CJ.a2021.0071. Epub 2021 Jul 26.
The purpose of this study was to compare the safety and clinical outcomes of transcarotid (TC) and transapical access (TA) transcatheter aortic valve implantation (TAVI) patients whom the transfemoral approach (TF) was not feasible.
The analysis included consecutive patients with severe symptomatic aortic stenosis treated from 2017 to 2020 with TC-TAVI or TA-TAVI in two high-volume TAVI centers. The approach was selected by multidisciplinary heart teams after analyzing multislice computed tomography of the heart, aorta and peripheral arteries, transthoracic echocardiography and coronary angiography.
One hundred and two patients were treated with alternative TAVI accesses (TC; n = 49 and TA; n = 53) in our centers. The groups were similar regarding age, gender, New York Heart Association class, and echocardiography parameters. Patients treated with TC-TAVI had significantly higher surgical risk. The procedural success rate was similar in both groups (TC-TAVI 98%; TA-TAVI 98.1%; p = 0.95). The rate of Valve Academic Research Consortium-2 defined clinical events was low in both groups. The percentage of new-onset rhythm disturbances and permanent pacemaker implantation was similar in TC and TA TAVI (4.1% vs. 11.3%; p = 0.17 and 10.2% vs. 5.7%; p = 0.39, respectively). In the TA-TAVI group, significantly more cases of pneumonia and blood transfusions were observed (11% vs. 0%; p = 0.01 and 30.2% vs. 12.2%; p = 0.03). The 30-day mortality was similar in TC and TA groups (4.1% vs. 5.7%; p = 0.71, respectively).
Both TC and TA TAVI are safe procedures in appropriately selected patients and are associated with a low risk of complications.
本研究旨在比较经颈动脉（TC）和经心尖（TA）入路经导管主动脉瓣植入术（TAVI）治疗经股动脉（TF）不可行的严重症状性主动脉瓣狭窄患者的安全性和临床结局。
分析纳入了 2017 年至 2020 年在两个高容量 TAVI 中心接受 TC-TAVI 或 TA-TAVI 治疗的连续严重症状性主动脉瓣狭窄患者。在对心脏、主动脉和外周动脉的多层螺旋 CT、经胸超声心动图和冠状动脉造影进行多学科心脏团队分析后，选择入路。
我们中心有 102 例患者采用替代 TAVI 入路（TC：n=49 例和 TA：n=53 例）进行治疗。两组在年龄、性别、纽约心脏协会（NYHA）分级和超声心动图参数方面相似。TC-TAVI 治疗的患者手术风险显著更高。两组的手术成功率相似（TC-TAVI：98%；TA-TAVI：98.1%；p=0.95）。两组的 Valve Academic Research Consortium-2 定义的临床事件发生率均较低。新发心律失常和永久性起搏器植入的比例在 TC 和 TA-TAVI 组相似（4.1%比 11.3%；p=0.17 和 10.2%比 5.7%；p=0.39）。在 TA-TAVI 组中，观察到肺炎和输血的病例明显更多（11%比 0%；p=0.01 和 30.2%比 12.2%；p=0.03）。TC 和 TA 组的 30 天死亡率相似（4.1%比 5.7%；p=0.71）。
在适当选择的患者中，TC 和 TA-TAVI 均为安全的手术，并发症风险低。
