Transcutaneous aortic valve implantation using the carotid artery access: Feasibility and clinical outcomes

Abstract

Transcarotid access is an alternative route for transcutaneous aortic valve implantation (TAVI) in patients with impossible transfemoral access. We evaluated the safety, effectiveness and early and late clinical outcomes of CoreValve® implantation via the common carotid artery. Eighteen patients (10 men, 8 women; mean age 84±5 years) at high surgical risk (mean EuroSCORE II 16±13%) with significant peripheral artery disease underwent TAVI via common carotid artery access under general anaesthesia. Mean aortic valve area was 0.64±0.13cm2 (0.36±0.07cm2/m2). At a mean follow-up of 605±352 days, two patients (11%) had died in hospital, on days 6 and 20, as a result of sepsis with multiorgan failure (n=1) or pneumonia (n=1). There were no perioperative deaths, myocardial infarctions or strokes. Perioperative prosthesis embolization occurred in one patient (6%), requiring implantation of a second valve. In-hospital complications occurred in four patients (23%): blood transfusion for transient significant bleeding at the access site in one patient (6%); permanent pacemaker implantation in two patients (11%); and pericardial drainage in one patient (6%). The rate of event-free in-hospital stay was 66%. Post-procedural echocardiography showed very good haemodynamic performance, with a mean gradient of 8±3mmHg. Moderate paravalvular leak was present in one patient (6%). Mean intensive care unit stay was 48±31h; mean in-hospital stay was 7±3 days. TAVI performed by transcarotid access in this small series of severely ill patients was associated with a low incidence of complications, which were associated with the procedure itself rather than the access route.