Carotid artery access for transcatheter aortic valve replacement

Abstract

We report three patients who had successful transcatheter aortic valve replacement (TAVR) via carotid artery access. None were candidates for thoracotomy (including minimal access incisions) and had no other vascular access sites that would accommodate the transcatheter valve sheath. Antegrade carotid perfusion and retrograde insertion of the delivery sheath maintained cerebral blood flow without sequelae. Carotid access for TAVR is an option for unusual patients without other access.

High-Risk Patients With Inoperative Aortic Stenosis: Use of Transapical, Transaortic, and Transcarotid Techniques

“…More recently, Hayashida and colleagues reported 30-day mortality as low as 7.4% in 94 patients undergoing TAo TAVR [21]. Regarding TC access outcomes, we reported the first successful TC TAVR [10]. Modine and colleagues [22] later reported feasibility and early outcomes for 12 patients who underwent TC TAVR, with no deaths in the perioperative or 30-day follow-up period.…”

“…However, there is a subset of patients for whom TF access is not possible because of size, tortuosity, or calcification of the femoral vessel. In response, alternative non-TF access routes have been developed such as transapical (TA), transaortic (TAo), and transcarotid (TC) approaches that offer good options for well-selected patients [7][8][9][10][11]. Although several studies have looked at these non-TF approaches individually, to date none has compared outcomes across these approaches.…”

A systematic review of transcatheter aortic valve implantation via carotid artery access

“…Three of the case series had sufficient detail for the data to be extracted as individual cases (6,13,14). One group, Azmoun et al, presented or published the same content with increasing patients in their series (15).…”

“…Some studies championed the left carotid as it offered a more direct approach (8,18,24), others the right carotid due to favourable angulation (13,23) and finally some sides were selected based on individual patient anatomy established on pre-operative imaging (14,15,22). This case-by-case decision-making based on the individual anatomy and surgeon preference seems to be the most sensible method at this time given the paucity of data.…”

Transcatheter aortic valve replacement

“…59 For example, Petronio et al published a case series comparing the subclavian and femoral access routes and reported similar outcomes with regard to mortality and morbidity, with no specific complications related to the former route. 60 Other alternative access routes that have been described include a carotid access 61 as well as a surgical cut down to the common iliac arteries. 62 Since randomized controlled trials comparing access routes are still awaited, larger clinical trials are necessary to specify the role of the different approaches for TAVR.…”