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

• Published in: Archives of cardiovascular diseases 2017-06, Vol.110 (6-7), p.389-394
• Main Authors: Kallinikou, Zacharenia, Berger, Alexandre, Ruchat, Patrick, Khatchatourov, Gregory, Fleisch, Isabelle, Korkodelovic, Branislav, Henchoz, Emmanuel, Marti, René-Andréas, Cook, Stéphane, Togni, Mario, Goy, Jean-Jacques
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Artère carotide commune; Artère fémorale; Artériopathie périphérique; Cardiovascular; Carotid Artery, Common - diagnostic imaging; Common carotid artery; Disease-Free Survival; Feasibility Studies; Female; Femoral artery; Femoral Artery - diagnostic imaging; Heart Valve Prosthesis; Hemodynamics; Hospital Mortality; Humans; Implantation transvalvulaire d’une valve aortique; Internal Medicine; Length of Stay; Male; Peripheral Arterial Disease - complications; Peripheral Arterial Disease - diagnostic imaging; Peripheral artery disease; Prospective Studies; Prosthesis Design; Recovery of Function; Sténose aortique; Time Factors; Transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Transcatheter Aortic Valve Replacement - methods; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2016.10.005

Summary Background Transcarotid access is an alternative route for transcutaneous aortic valve implantation (TAVI) in patients with impossible transfemoral access. Aims We evaluated the safety, effectiveness and early and late clinical outcomes of CoreValve® implantation via the common carotid artery. Methods 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 ± 0.13 cm2 (0.36 ± 0.07 cm2 /m2 ). Results 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 ± 3 mmHg. Moderate paravalvular leak was present in one patient (6%). Mean intensive care unit stay was 48 ± 31 h; mean in-hospital stay was 7 ± 3 days. Conclusion 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.