Abstract
This study aimed to prospectively evaluate the safety and long-term clinical outcomes of cerebral-oximetry-guided transcarotid transcatheter aortic valve implantation (TC-TAVI) with systematic follow-up with carotid ultrasound. Thirty-three TCTAVI procedures were performed in our center from 2017 to 2019. Our analysis includes in-hospital outcomes and long-term follow-up data on mortality, echocardiographic parameters, carotid Doppler ultrasound, and VARC-2 defined clinical events. Intraoperatively, one patient died, and one had a transient ischemic attack (TIA). The following events occurred in-hospital postoperatively: myocardial infarction (3.0%), cardiac tamponade (3.0%), new-onset atrial fibrillation (6.3%), need for temporary pacing (27.3%) and need for pacemaker implantation (15%). The mean follow-up was 19.5 ± 9.52 months. In the long-term follow-up, the two-year survival rate was 83% ± 14. The echocardiographic parameters did not differ significantly from the postprocedural values, and the ultrasound did not show any cases of significant vessel narrowing. The mean peak systolic velocity (PSV) was 71.6 cm/s in the left common carotid artery and 70.6 cm/s in the right common carotid artery. In conclusion, cerebral oximetry-guided TC access is safe, has a favorable long-term outcome, and does not increase the risk of plaque formation in the carotid artery. In a carefully selected group of patients, it might be considered as a first-choice alternative to TF access.
Highlights
Introduction iationsOne of the main goals of TAVI operators is to reduce the risk of vascular complications (VC), which frequently occurred during the early days of the TAVI experience
The current paper provides long term outcomes with routine follow-up with carotid duplex ultrasound (DUS) of all patients treated with transcatheter aortic valve implantation (TC-TAVI) in a large academic institution where TC is the preferred alternative access when TF is not feasible
Thirty-three TC-TAVI procedures performed in the Upper-Silesian Medical Center of the Medical University of Silesia in Katowice, Poland, from September 2017 to November
Summary
Introduction iationsOne of the main goals of TAVI operators is to reduce the risk of vascular complications (VC), which frequently occurred during the early days of the TAVI experience. The complications were mostly related to suboptimal aortic and iliofemoral anatomy in high-risk patients. In high-risk patients, the extent of calcifications, a small diameter of the common femoral and iliac arteries, and diffuse atherosclerosis preclude a safe TF procedure. The use of alternative access routes has allowed TAVI to be carried out in patients in whom TF could not be performed. Such alternative access techniques include the transapical (TA), trans-axillary, direct aortic, trans-caval, and trans-carotid (TC) approach. The TA approach was the first to be used, and the clinical evidence related to the alternative TAVI access is related mostly to Licensee MDPI, Basel, Switzerland
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
