title: Transcarotid Transcatheter Aortic Valve Replacement: Feasibility and Safety.
abstract: OBJECTIVE
  The purpose of this study was to assess the feasibility and safety of transcarotid transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  Many candidates for TAVR have challenging vascular anatomy that precludes transfemoral access. Transcarotid arterial access may be an option for such patients.
  
  
  METHODS
  The French Transcarotid TAVR Registry is a voluntary database that prospectively collected patient demographics, procedural characteristics, and clinical outcomes among patients undergoing transcarotid TAVR. Outcomes are reported according to the updated Valve Academic Research Consortium criteria.
  
  
  RESULTS
  Among 96 patients undergoing transcarotid TAVR at 3 French sites (2009 to 2013), the mean age and Society of Thoracic Surgeons predicted risk of mortality were 79.4 ± 9.2 years and 7.1 ± 4.1%, respectively. Successful carotid artery access was achieved in all patients. The Medtronic CoreValve (Medtronic, Inc., Minneapolis, Minnesota) (n = 89; 92.7%) and Edwards SAPIEN valves (Edwards Lifesciences, Irvine, California) (n = 7; 7.3%) were used. Procedural complications included: valve embolization (3.1%), requirement for a second valve (3.1%), and tamponade (4.2%). There were no major bleeds or major vascular complications related to the access site. There were 3 (3.1%) procedural deaths and 6 (6.3%) deaths at 30 days. The 1-year mortality rate was 16.7%. There were 3 (3.1%) cases of Valve Academic Research Consortium-defined in-hospital stroke (n = 0) or transient ischemic attack (TIA) (n = 3). None of these patients achieved the criteria for stroke and none manifested new ischemic lesions on cerebral computed tomography or magnetic resonance imaging. At 30 days, a further 3 TIAs were observed, giving an overall stroke/TIA rate of 6.3%.
  
  
  CONCLUSIONS
  Transcarotid vascular access for TAVR is feasible and is associated with encouraging short- and medium-term clinical outcomes. Prospective studies are required to ascertain if transcarotid TAVR yields equivalent results to other nonfemoral vascular access routes.
authors.affiliation: University Hospital Galway, Galway, Ireland.
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.affiliation: Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Lille, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Sudre
authors.affiliation: Hopital Mondor, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.affiliation: Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France.
authors.forename: Jean François
authors.initials: JF
authors.lastname: Obadia
authors.affiliation: University Hospital Galway, Galway, Ireland.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lee
authors.affiliation: Royal Victoria Hospital, Belfast Trust, Queen's University Belfast, Belfast, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Spence
authors.affiliation: Department of Cardiology, October 6 University, Cairo, Egypt.
authors.forename: Hazem
authors.initials: H
authors.lastname: Khamis
authors.affiliation: Cardiology Department, Al Qassimi Hospital, Dubai, United Arab Emirates.
authors.forename: Arif
authors.initials: A
authors.lastname: Al Nooryani
authors.affiliation: Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Lille, France.
authors.forename: Cedric
authors.initials: C
authors.lastname: Delhaye
authors.affiliation: Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Lille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Amr
authors.affiliation: Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Lille, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Koussa
authors.affiliation: Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Debry
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.affiliation: Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Lille, France. Electronic address: t1modine@yahoo.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D017023:Coronary Angiography; D005240:Feasibility Studies; D005260:Female; D005602:France; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D017585:Ultrasonography, Doppler, Transcranial
keywords: aortic stenosis; carotid vascular access; transcatheter aortic valve replacement