Del Portillo Juan Hernando, Cepas-Guillén Pedro, Kalavrouziotis Dimitri, Dumont Eric, Porterie Jean, Paradis Jean-Michel, Poulin Anthony, Beaupré Frederic, Avvedimento Marisa, Mas-Peiro Silvia, Mengi Siddhartha, Mohammadi Siamak, Rodés-Cabau Josep
Quebec Heart and Lung Institute, Laval University, Canada.
Circ Cardiovasc Interv. 2025 Apr;18(4):e014928. doi: 10.1161/CIRCINTERVENTIONS.124.014928. Epub 2025 Mar 26.
Current guidelines recommend surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis and unfavorable iliofemoral access. Transcarotid transcatheter aortic valve replacement (TC-TAVR) has emerged as an alternative access in suboptimal transfemoral candidates, but no data exist comparing TC-TAVR and SAVR. The main objective of this study was to compare the clinical outcomes in a propensity-matched population of TC-TAVR and SAVR patients with severe aortic stenosis.
A total of 786 patients (SAVR, 352; TC-TAVR, 434) were included, and a total of 182 patients were propensity-matched and included in each group. The primary outcome was a composite of death from any cause, stroke/transient ischemic attack, and procedure-related or valve-related hospitalization at 30 days and at 1 year. Data were prospectively collected in dedicated databases, and clinical events were defined according to Valve Academic Research Consortium-3 criteria.
Baseline characteristics were well balanced between the matched groups, and the mean age and Society for Thoracic Surgeons score of the study population were 75 years and 3.6%, respectively. At 30 days, the SAVR group showed a higher rate of the primary composite outcome compared with the TC-TAVR group (12.6% versus 4.3%; hazard ratio, 2.93 [95% CI, 1.45-5.94]). Acute kidney injury stages 2 to 4, bleeding events, and new-onset atrial fibrillation occurred more often in the SAVR group during the hospital period (<0.001). In contrast, vascular complications and the need for permanent pacemaker implantation occurred more often in the TC-TAVR group (=0.01 and =0.001, respectively). At 1-year follow-up, there were no significant differences between groups in the primary outcome rates (SAVR, 19.7% versus TC-TAVR, 12.7%; hazard ratio, 1.63 [95% CI, 0.98-2.73]).
TC-TAVR was associated with improved 30-day clinical outcomes compared with SAVR, with no significant differences in death, stroke, and hospitalization at 1-year follow-up. These findings suggest that TC-TAVR may be a valid alternative to SAVR in nontransfemoral-TAVR candidates.
当前指南推荐对严重主动脉瓣狭窄且髂股入路不佳的患者进行外科主动脉瓣置换术（SAVR）。经颈动脉经导管主动脉瓣置换术（TC-TAVR）已成为经股动脉入路欠佳患者的一种替代入路，但尚无比较TC-TAVR和SAVR的数据。本研究的主要目的是比较倾向评分匹配人群中严重主动脉瓣狭窄的TC-TAVR和SAVR患者的临床结局。
共纳入786例患者（SAVR组352例，TC-TAVR组434例），每组纳入182例倾向评分匹配患者。主要结局是30天和1年时任何原因导致的死亡、卒中/短暂性脑缺血发作以及与手术相关或与瓣膜相关的住院的复合结局。数据前瞻性收集于专用数据库，临床事件根据瓣膜学术研究联盟-3标准定义。
匹配组间基线特征均衡，研究人群的平均年龄和胸外科医师协会评分分别为75岁和3.6%。30天时，SAVR组主要复合结局发生率高于TC-TAVR组（12.6%对4.3%；风险比，2.93[95%CI，1.45-5.94]）。住院期间，SAVR组急性肾损伤2至4期、出血事件和新发房颤发生率更高（<0.001）。相比之下，TC-TAVR组血管并发症和永久起搏器植入需求发生率更高（分别为=0.01和=0.001）。1年随访时，两组主要结局发生率无显著差异（SAVR组19.7%对TC-TAVR组12.7%；风险比，1.63[95%CI，0.98-2.73]）。
与SAVR相比，TC-TAVR与30天临床结局改善相关，1年随访时死亡、卒中和住院方面无显著差异。这些发现表明，在非经股动脉TAVR候选患者中，TC-TAVR可能是SAVR的有效替代方案。
