Transcarotid versus transfemoral transcatheter aortic valve replacement: A systematic review and meta-analysis

Background: In the 2021 Transcatheter Valve Therapy (TVT) registry, 8.9 % of patients underwent TAVR via access sites other than the femoral artery. Transthoracic approaches may be contraindicated in some patients and may be associated with poorer outcomes. Therefore other alternative access routes are increasingly being performed. We conducted a systematic review of the literature on transcarotid transcatheter aortic valve replacement (TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access routes. Methods: We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We presented data using risk ratios (95 % confidence intervals) and measured heterogeneity using Higgins' I2. Results: Sixteen observational studies on transcarotid TAVR were included in the analysis; 4 studies compared TC-TAVR vs TF-TAVR. The mean age and STS score for patients undergoing TC-TAVR were 80 years and 7.6 respectively. For TF-TAVR patients, mean age and STS score were 81.2 years and 6.5 respectively. There was no difference between patients undergoing TC-TAVR and TF-TAVR in the following 30-day outcomes: MACE [8.4% vs 6.7%; OR 1.32 (95 % CI 0.71-2.46 p = 0.38) I2 = 0%], mortality [5.6% vs 4.0%; OR 0.42 (95% CI 0.60-3.37, P = 0.42) I2 = 0%] and stroke [0.7 % vs 2.3 %; OR 0.49 (95 % CI 0.09-2.56, P = 0.40) I2 = 0 %]. There was no difference in 30-day major vascular complications [0.7 % vs 3 %; OR 0.55 (95 % CI 0.06-5.29, P = 0.61) I2 = 39%], major bleeding [0.7% vs 3.8 %; OR 0.39 (95 % CI 0.09-1.67, P = 0.21) I2 = 0%], and moderate or severe aortic valve regurgitation [8.6% vs 9.9%; OR 0.89 (95 % CI 0.48-1.65, P = 0.72) I2= 0 %]. Conclusion: There are no significant differences in mortality, stroke MACE and major or life-threatening bleeding or vascular complications when TC-TAVR is compared to TF-TAVR approaches.