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Brachiocephalic Trunk And Right Carotid Access For Tavi: Same Artery Different Approaches
Maude-Emmanuelle Olivier1, Chadi Aludaat1, Thomas Levasseur2, Laurent Faroux2, Pierre-Frédérique Torossian1, Sophie Tassan-Mangina2, Benoit Herce2, Alain Deschildre2, Damien Metz2, Vito-Giovanni Ruggieri1.
1Service de Chirurgie Thoracique et Cardio-Vasculaire, Hôpital Robert Debré, CHU de REIMS, France, 2Service de Cardiologie, Hôpital Robert Debré, CHU de REIMS, France.
OBJECTIVE: With growing of indications for transcatheter aortic valve implantation (TAVI), a significant number of patients are not eligible for trans-femoral access. Many alternatives have been described. Vascular and neurological access-related complications remain problematic. We report our experience of TAVI via brachiocephalic artery (BCA) and right carotid artery (RCA) in order to express potential advantages and results of each access.
METHODS: Twenty-tree patient underwent TAVI between September 2014 and September 2016. In 12 patients we used the BCA access and in 11 patients the RCA access. Mean age was 80.1±15.8 years; the logistic Euroscore was 24.9±11.5. The choice for non-femoral access was achieved after clinical and CT images screening. The extra-pericardial BCA was conducted under general anaesthesia through a J-shaped manubriotomy. The RCA access was performed through cervical cut down under loco regional anaesthesia. The valve Academic Research Consorsium-2 (VARC-2) criteria was used to define the procedural feasibility, device success and post-operative outcomes.
RESULTS: The Edwards SAPIEN 3 (Edwards Lifesciences, Irvine, California) (n= 20; 87%) and the Medtronic Corvalve (Medtronic, Inc., Mineapolis, Minnesota) (n= 3; 13%) were used. All patients were successfully implanted. No conversion to surgery was registered. There were neither procedural deaths nor in-hospital deaths. One minor bleeding was registered in the BCA group. There was no minor or major stroke. Post implant echocardiographic control showed a satisfactory transvalvular gradient in both groups. No grade 2 paravalvular leak or greater was detected at discharge. Follow-up (mean 10 ±3 months) was complete. One non-cardiac death was registered. Echocardiographic control showed satisfactory results.
CONCLUSIONS: BCA and RCA access for TAVI have to be considered as two entries of the same route. In our experience, these different grades should select our results. Each technique showed potential advantages and should be considered as valuables alternatives to patients with unfavourable femoral access for TAVI.
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