• Aurélien Villecourt, Laurent Faroux, Alexandre Muneaux, Sophie Tassan-Mangina, Virginie Heroguelle, Anne Poncet, Pierre Nazeyrollas, Vito Giovanni Ruggieri, and Damien Metz.
• Department of Cardiology, hôpital Robert-Debré, Reims University Hospital, rue du Général-Koenig, 51092 Reims, France.
• Arch Cardiovasc Dis. 2020 Mar 1; 113 (3): 189-198.

BackgroundTranscarotid and trans-subclavian access routes are increasingly used as alternative approaches for transcatheter aortic valve implantation (TAVI) when transfemoral access is not suitable. However, concerns remain about the risk of periprocedural stroke and long-term outcomes following transcarotid/trans-subclavian TAVI.AimsThe present study sought to compare early and long-term outcomes of transcarotid/trans-subclavian TAVI versus transfemoral TAVI after propensity-score matching.MethodsThe 260 patients who underwent TAVI through a transfemoral (n=220), transcarotid (n=32) or trans-subclavian (n=8) approach at our institution over a 4-year period were identified. A 1:1 matching based on propensity score was performed, and led to a study population of 80 patients (40 transfemoral and 40 transcarotid/trans-subclavian). Primary endpoints were early complications; secondary endpoints were long-term outcomes.ResultsThere were no differences in the baseline characteristics of the two groups. At 30 days after TAVI there were no significant differences between transfemoral and transcarotid/trans-subclavian TAVI in terms of death rates (5% vs 5%, respectively; P=1.00) and stroke rates (5% vs 2.5%, respectively; P=1.00). After a median follow-up of 21 months, the risk of death (P=0.95), stroke (P=0.82) and myocardial infarction (P=0.16) did not differ between the two groups.ConclusionsAfter propensity-score matching, no significant differences in early and long-term outcomes were observed between transfemoral and transcarotid/trans-subclavian TAVI. These findings should encourage heart teams to consider a transcarotid or trans-subclavian approach when transfemoral access is unavailable.Copyright © 2020 Elsevier Masson SAS. All rights reserved.

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