Transcarotid vs Subclavian/Axillary Access for Transcatheter Aortic Valve Replacement with SAPIEN 3.

Document Type


Publication Date


Publication Title

The Annals of thoracic surgery




BACKGROUND: Subclavian/Axillary (TAx) Access has become the most frequently used alternative access route for Transcatheter Aortic Valve Replacement (TAVR). Transcarotid (TC) TAVR has grown in popularity recently. Comparative data between these two contemporary access methods is lacking.

METHODS: Data were extracted from the STS/ACC TVT Registry™ (June 2015 to October 2019) for patients undergoing TAVR via TC or TAx access with the SAPIEN 3 and SAPIEN 3 Ultra transcatheter heart valves. Procedural, index hospitalization, and 30-day outcomes were analyzed for TC vs. TAx groups after 1:2 propensity matching of patient baseline characteristics.

RESULTS: 3903 cases were included of which 801 TC and 3102 TAx procedures were compared. After 1:2 propensity matching, TC TAVR was associated with similar 30-day mortality (4.3% vs. 5.2%, P=0.34) but significantly lower risk of stroke (4.2% vs. 7.4%, HR 0.56 [95% CI:0.38-0.83] P=0.003) compared to TAx access. Other outcomes that favored TC over TAx included shorter procedure time (117.0 vs 132.4 min; P

CONCLUSIONS: TC TAVR is associated with similar mortality and significant reduction in stroke compared to the subclavian/axillary approach. If femoral access is precluded, TC may be a safe, or at times, preferred avenue of transcatheter valve delivery.

Clinical Institute

Cardiovascular (Heart)




Center for Cardiovascular Analytics, Research + Data Science (CARDS)