Abstract
INTRODUCTION: Transcarotid (TC) access in transcatheter aortic valve replacement (TAVR) has been performed as one of alternative options when transfemoral (TF) access is not feasible. Short-term outcomes of TC compared with TF access were reported, however, mid to long-term outcome is poorly documented. METHODS: Between May 2019 and September 2023, 1578 patients underwent TAVR with balloon expandable valve. Of 1578, 86 had TAVR through TC access, TF access in 1492. Propensity score matching was performed among the two groups and postoperative outcomes were evaluated using log-rank test and Cox proportional hazards model. RESULTS: 86 pairs were matched. There was no significant difference in 30 day mortality rate between TC and TF group, which were 3.5% (3/86) and 0% (0/86), respectively (p = 0.25). The incidence of postoperative in-hospital stroke was similar (TC: 6.9% (6/86) vs. TF: 3.5% (3/86), p = 0.30). The cumulative 5-year survivals of patients in TC and TF groups were 60.6% and 76.4%, respectively. A significant difference was not noted between the two groups (p = 0.06). On multivariate analysis, past medical history of atrial fibrillation, reduced left ventricular ejection fraction, and TC access were associated with increased mid to long-term mortality. The incidence of stroke at 5year follow-up in TC group did not differ compared with that of TF group (16.6% versus 9.7%, p = 0.49). TC access was not a predictor for late stroke (p = 0.40). CONCLUSIONS: Transcarotid access should be an alternative access when transfemoral access is not feasible. Transcarotid access might increase the long-term mortality, however, not a risk factor for postoperative stroke.