Transaxillary Access Compared With Transcarotid Access for TAVR in French Registry

November 24, 2020—A study sought to understand whether transcarotid (TC) or transaxillary (TAx) should be the preferred approach for transcatheter aortic valve replacement (TAVR) by comparing their outcomes using a propensity-matched comparison in a French multicenter registry. Investigators found that 1-month mortality, 1-month stroke/transient ischemic attack (TIA), and 1-year mortality are similar with TAx-TAVR and TC-TAVR. However, TC-TAVR is accompanied by more minor bleeding and main access hematoma compared with the TAx route.

The study was presented at the 2020 PCR Valves eCourse that was held as a virtual conference on November 22-24. Nicolas Debry, MD, et al published the findings in EuroIntervention (2020;16:842-849).

As summarized in EuroIntervention, the French multicenter, prospective registry included 502 patients treated for symptomatic aortic stenosis by undergoing TC-TAVR (n = 374) and TAx-TAVR (n = 128) from 2010 to 2018.

Patients treated through TAx access were matched 1:2 with patients treated through the TC route by using a propensity score (20 clinical, anatomic, and procedural variables) and by date of the procedure.

The first outcome was mortality at 1-month follow-up. The second outcome was 1-month stroke/TIA.

In EuroIntervention, the investigators reported the following:

• In propensity-matched analyses, the incidence of the primary outcome was similar in the TAx and TC groups (5.5% vs 4.5%; odds ratio [OR], 1.23; 95% CI, 0.40-3.70)
• The secondary outcome was similar in TAx and TC (3.2% vs 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
• The 1-month clinical efficacy and safety and 1-year mortality did not differ according to the different routes