Patient Recovery following Transcarotid or Transthoracic Transcatheter Aortic Valve Replacement

ABSTRACT

Background: Patient recovery following alternative-access transcatheter aortic valve replacement (TAVR) via transcarotid (TC) and transthoracic (TT; transapical or transaortic) access has not been well-studied.

Methods: We retrospectively analyzed single-center data from 100 consecutive patients who underwent TAVR via TC (n = 57) and TT (n = 43) access between 2008 and 2018. The primary outcomes were pain severity (0–10 scale) and opioid administration. Secondary outcomes included procedure success, post-procedure length of stay (LOS), PACU/ICU LOS, time to ambulation, discharge disposition, and health status as measured by Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) at 30-day follow-up. Multivariable regression models were used to adjust for baseline patient characteristics.

Results: Procedural success was similar for the TC and TT groups (98.2% vs 97.7%, p = 1.00). In adjusted analyses, TC patients had shorter PACU/ICU LOS (RD 0.30, p < 0.001) and shorter post-procedural LOS (RD 0.46, p < 0.001) compared with TT patients. At 48 hours, TC patients reported lower pain scores (absolute difference −1.0, p = 0.02) despite less opioid administration (RD 0.39, p < 0.001). Time to ambulation was similar between groups (p = 0.54), but TC patients were more frequently discharged to home (73.7% vs. 32.6%; p < 0.001). TC patients had greater improvement in (24.9 ± 23.9 vs −2.5 ± 31.0, <0.001) and higher overall KCCQ-OS (63.4 ± 22.5 vs 39.8 ± 23.1, p < 0.001) scores at 30 days than TT patients.

Conclusions: In this single-center study among patients undergoing alternative-access TAVR, TC access was associated with less opioid administration, lower pain scores, shorter LOS, more frequent discharge to home, and better health status at 30 days as compared with TT access.

KEYWORDS:

• TAVR
• aortic stenosis
• opioids
• transcarotid
• transapical
• transaortic
• pain

Disclosure statement

Keith B. Allen MD, Abbott Vascular: Consultant; Boston Scientific: Consultant; Edwards Lifesciences: Research Grant, Consultant, Proctor, Speakers bureau; Medtronic Inc: Research Grant, Consultant, Speakers bureau. John T. Saxon MD, Abbott Vascular: Speakers bureau, Proctor; Medtronic Inc: Speakers bureau, Proctor. David J. Cohen MD, MSc, Abbott Vascular: Research Grant, Consultant; Boston Scientific: Research Grant, Consultant; Edwards Lifesciences: Research Grant, Consultant; Medtronic Inc: Research Grant, Consultant. Adnan K. Chhatriwalla MD, Abbott Vascular: Speakers bureau; Boston Scientific: Consultant, Research Grant; Edwards Lifesciences: Speakers bureau, Proctor; Medtronic Inc: Speakers Bureau, Proctor; Silk Road Medical: Consultant.

Additional information

Funding

This work was supported by the American College of Cardiology: Missouri Chapter. The views expressed in this manuscript represent those of the author(s), and do not necessarily represent the official views of the ACC.