Transcarotid Approach for Transcatheter Aortic Valve Replacement: First Results of an Alternative Access

Objectives: The transcarotid vascular access is a less invasive alternative to the transapical access in patients with contraindications for transfemoral access undergoing TAVR. We analyzed the first results of our center with this approach.

Methods: Between 01/19 and 08/20, a total of 391 patients underwent TAVR at the Heartcenter Lahr/Baden, 16 patients (4.1%) received a transcarotid vascular access. Pre-, intra-, and postprocedural data were prospectively collected in a dedicated database and analyzed retrospectively. Complications were evaluated after VARC-II criteria.

Result: The mean patient age was 79.1 ± 6.8 and 8 (53.3%) patients were female. Twelve patients received TAVR with an Evolut R prosthesis and 4 patients with the Edwards Sapien 3. Mean implantation time was 80.3 ±30 minutes. All patients were in general anesthesia. In all patients the implantation was uneventful and 15 of the patients were discharged after 8.1 ± 4.1 days after TAVR with a postoperative mean gradient of 12.3 ± 6 mm Hg. In one patient the transcarotid vascular access was intraoperatively used as a bailout strategy, in six patients as a bailout with a second implantation attempt and in nine patients the transcarotid vascular access was used based on initial planning. In one patient venous pericardial effusion was detected intraoperatively, which was most likely through the placement of the pacemaker. One other patient received the TAVR through an occluded right internal carotid artery and experienced a neglect and a hemiparesis afterward. Most likely due to a border zone infarction.

Conclusion: The transcarotid vascular access can be used as a safe and immediate bailout strategy in patients with unexpected difficulties for transfemoral access or as a feasible alternative in patients with contraindication for the standard femoral access.

Publikationsverlauf

Artikel online veröffentlicht:
19. Februar 2021