Reply: Transcarotid trumps transapical/direct aortic access for transcatheter aortic valve replacement —It's a no brainer!

We appreciate the interest that Dr Useini1 showed in our recent article, “Transcarotid versus transthoracic access for transcatheter aortic valve replacement: a propensity-matched analysis.”2 Although we agree that the need for nonfemoral access is declining, Useini's insistence on clinging to an intrathoracic (transapical/direct aortic) access when femoral access is inadequate is misguided. In a propensity-matched analysis using the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapy (TVT) Registry, compared with transapical/direct aortic access using the SAPIEN 3 heart valve, transcarotid access was associated with lowe r in-hospital mortality (2.4% vs 5.7%; P = .0009) and 30-day mortality (4.2% vs 7.7%; P = .004), less new-onset atrial fibrillation (2.2% vs 12.1%; P 
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Letter to the Editor Source Type: research