Transcatheter aortic valve implantation through carotid artery access under local anaesthesia
Selected in European Journal of Cardio-Thoracic Surgery by Rylski
A. Azmoun, N. Amabile, R. Ramadan, S. Ghostine, C. Caussin, S. Fradi, F. Raoux, P. Brenot, R. Nottin, P. Deleuze
Eur J Cardiothorac Surg. 2014 Oct;46(4):693-8.
LinkAccess the abstract
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The most commonly used access for transcatheter aortic valve implantation (TAVI are trans-femoral and transapical. An alternative is TAVI via common carotid artery. The authors report a series of patients undergoing trans-carotid TAVI under local anaesthesia.
- Overall, 19 of 361 TAVI patients underwent aortic valve implantation via trans-carotid root (age 82 ± 6 years old, EuroScore 25 ± 16) under local anaesthesia.
- An 18-Fr or 20-Fr sheath was inserted into the common carotid artery (8 right, 11 left) to access ascending aorta.
- There was 1 intraoperative death by annulus rupture and 1 in-hospital death due to multisystem organ failure.
- There was no stroke or major bleeding. No access-site related complication occurred.
- Three patients required pacemaker implantation.
The authors’ main conclusion was that trans-carotid access under local anaesthesia for TAVI procedures is feasibly and safe. It is important to mention, that prior to TAVI procedure they assessed in CT-angiography carotid artery anatomy and additionally performed carotid cross-clamping test verifying patient’s neurological status stability. These seem to be key success factors for this challenging access site. This study on 19 patients does not allow drawing any definitive conclusion regarding the safety, however trans-carotid TAVI under local anaesthesia appears feasible. Numerous advantages of this access site make it attractive and we will probably hear soon other reports with larger number of patients and more robust data on this brave approach.