Abstract
BackgroundThe ACURATE neo™ transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) is predominantly implanted via femoral access. Transcarotid use of this prothesis has never been reported.Case presentationWe present the case of an 89-year-old woman referred to us for a transcatheter aortic valve replacement (TAVR). After apparatus imaging of the aortic annulus and the peripheral vascular pathway, the heart team was confronted with a triple challenge: (i) The preferable choice of a self-expanding valve because of a small aortic annulus in an obese woman. (ii) Gaining favorable access to the coronary ostia, considering multiple recent coronary stenting. (iii) Utilizing an alternative arterial access because of iliac and femoral severely calcified stenosis. Implanting the ACURATE neo™ transcatheter heart valve (THV) via carotidal access allowed us to overcome these challenges. The procedure was performed successfully without any short-term complications.ConclusionWe report the first case of implantation of an ACURATE neo™ transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) via the right common carotid artery.
Highlights
The ACURATE neoTM transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) is predominantly implanted via femoral access
[2] Here, we report the first implantation of an ACURATE neoTM aortic valve system via the right common carotid artery access (RCCA)
As in our usual practice for transcarotid transcatheter aortic valve replacement (TAVR), continuous cerebral perfusion was monitored by cerebral tissue oxygen saturation measurement with the near infrared spectroscopy (NIRS) cerebral oximeter (O3TM, Masimo, Irvine, CA)
Summary
In patients ineligible for transcatheter aortic valve replacement (TAVR) via the traditional femoral access route due to severe peripheral vascular disease, carotid artery access is a suitable alternative thoracic access route [1, 2]. While Self-expanding CoreValve® (Medtronic, Minneapolis, MN, USA) were the first transcatheter heart valves (THV) to be implanted via this non-femoral access [2] Here, we report the first implantation of an ACURATE neoTM aortic valve system via the right common carotid artery access (RCCA). Prothesis placement was performed in the standard fashion, and the up-to-down deployment was satisfactory with enhanced stability because of the short distance between the arterial carotid access and the aortic annulus (Fig. 1C). After a satisfactory angiogram (Fig. 1D), the iSLEEVETM introducer was removed, and the common carotid artery was surgically purged and repaired using a 6–0 polypropylene running suture. Based on the Valve Academic Research Consortium (VARC 2) criteria, we recorded no complications
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