A systematic review of transcatheter aortic valve implantation via carotid artery access

Stonier, Thomas, Harrison, Michael and Choong, Andrew M. T. L. (2016) A systematic review of transcatheter aortic valve implantation via carotid artery access. International Journal of Cardiology, 219 41-55. doi:10.1016/j.ijcard.2016.05.049

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Author Stonier, Thomas
Harrison, Michael
Choong, Andrew M. T. L.
Title A systematic review of transcatheter aortic valve implantation via carotid artery access
Journal name International Journal of Cardiology   Check publisher's open access policy
ISSN 1874-1754
0167-5273
Publication date 2016-09-15
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.ijcard.2016.05.049
Open Access Status File (Author Post-print)
Volume 219
Start page 41
End page 55
Total pages 15
Place of publication Shannon, Clare Ireland
Publisher Elsevier Ireland
Collection year 2017
Language eng
Formatted abstract
Background

The carotid artery is a novel access route for transcatheter aortic valve implantation (TAVI). This may represent a viable alternative in patients unsuitable for TAVI via traditional transfemoral access, up to 20%, as well as other access routes such as subclavian, transapical and aortic. This systematic review summarises the current evidence for its safety and feasibility.

Methods

A systematic review was conducted as per the Preferred Reporting Instructions for Systematic Reviews and Meta-analysis (PRISMA) guidelines using five electronic databases.

Results

16 studies were identified, including three prospective cohort studies, one retrospective cohort study, three case series and eight case reports. Data on 74 patients (mean age 76.9 years) was extracted including pre-operative work-up, technical procedure details and outcomes.

This found 1 intraoperative death, 2 further deaths within 30 days, two incidences of transient ischaemic attack, no incidences of stroke, myocardial infarction, carotid access site complications or infection, 1 patient required new dialysis and 1 patient had an intraoperative dissection which resolved. Follow-up from 30 days to 1 year showed symptomatic improvement and echocardiographic improvement in line with those seen in transfemoral TAVI.

Conclusions

The available data on TAVI via carotid access demonstrate technical feasibility with comparable outcomes to other traditional access routes. A low number of patients, heterogeneous clinical endpoints and relatively short follow-up periods limit formal meta-analysis and firmer conclusions. For patients in which other access routes are impossible, TAVI via carotid access represents a viable and potentially crucial alternative in patients who might otherwise be untreatable.
Keyword Transcatheter aortic valve
TAVI
Carotid
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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