Trans-carotid access for TAVR allows safe and rapid exchange for bailout valve-in-valve procedures

Abstract

Trans-carotid access for trans-catheter aortic valve replacement is a valid alternative in patients with aortic valve dysfunction, severe peripheral vascular disease, and high-risk for surgery. However, in the event of the need for a bailout valve-in-valve procedure, the safety of this access site is uncertain. We report a patient with aortic regurgitation, previous coronary surgery, peripheral vascular disease, and impaired ventricular function who underwent a CoreValve Evolut-R (Medtronic Inc, Minneapolis, MN) implantation through the left carotid artery followed by a successful valve-in-valve procedure with a 26-mm Edwards Sapien3 valve (Edwards Lifesciences, Irvine, CA) through the same carotid access site.

Endovascular management of an aortic rupture following transcatheter aortic valve replacement

“…In retrospect, employing a device with a deflectable delivery sheath, such as the Sapien prothesis (Edwards Lifesciences Inc., Irvine, CA) or a more flexible device such as the Portico (St. Jude Medical, St. Paul, MN) might have been a better choice for this patient. Alternatively, a transaortic, transapical, transcarotid, or transaxillary approach could be considered for TAVR patients with an acutely angulated aortic arch . This case emphasizes the importance of the Heart Team approach for all TAVR cases to optimize outcomes when complications occur .…”

Trans-carotid endovascular repair of ascending aortic pseudoaneurysms

“…Transcarotid access for transcatheter aortic valve implantation has been widely used when transfemoral or subclavian access is challenging. This has been met with some enthusiasm because of low rates of strokes and complications . However, the sheath size for TEVAR continues to be larger than for transcatheter aortic valve replacement (TAVR) and it is important to ensure that the carotid artery is of adequate size.…”

“…This has been met with some enthusiasm because of low rates of strokes and complications. 6,7 However, the sheath size for TEVAR continues to be larger than for transcatheter aortic valve replacement (TAVR) and it is important to ensure that the carotid artery is of adequate size. Lack of contralateral disease, intact circle of Willis, absence of ipsilateral plaque, or complete ipsilateral distal carotid occlusion are indications for the use of this approach.…”

Balloon aortic valvuloplasty via a bilateral trans-radial artery approach prior to transcatheter aortic valve replacement

“…The innominate artery is another potential site but requires a partial sternotomy . In addition, the transcarotid approach can also be used and allows safe and rapid exchange for bailout procedures should they be necessary …”