First European Case Of Transcervical Transcatheter Aortic Valve Replacement
Otto E. Dapunt1, Birgit Zirngast1, Cristiano Spadaccio2, Fraser WH Sutherland2.
1Medical University of Graz, Graz, Austria, 2Golden Jubilee National Hospital, Glasgow, United Kingdom.
OBJECTIVE: To report the short-term outcomes of the first European case of Transcervical Transcatheter Aortic Valve Replacement(TAVR) performed using the CoreVista Retractor.
METHODS: 84 year-old male with symptomatic(NYHA class III), degenerative aortic stenosis candidate for TAVR and considered unsuitable for conventional trans-femoral (TF) approach on account of hostile ileo-femoral anatomy. Exposure of the brachiocephalic artery at its origin from the aorta was obtained using the CoreVista Retractor and a single 26mm Edwards SAPIEN S3 TAVI valve prosthesis was successfully deployed according to standard procedure. Valve performance and clinical outcomes were evaluated according to the latest version of VARC criteria.
RESULTS: Vascular access to the origin of the brachiocephalic trunk at the aorta was achieved without major vascular injury or other complication. A single prosthesis was implanted in the correct final position without valve migration or embolization. A trace of prosthetic central regurgitation was detected and deemed acceptable. Patient made an unremarkable recovery and was discharged home on the day 6 without complication. During his hospital stay transcervical wound healed normally without need for transfusion or drains. At 30-days follow-up patient was asymptomatic (NYHA class) with no major cardiac events, aortic re-intervention or need for pacemaker. Imaging confirmed good valve performance with no paravalvular leaks.
CONCLUSIONS: Transcervical TAVR is feasible allowing for safe exposure and access to the aorta and closely related structures to perform the procedure. The transcervical access might minimize the risk of major access-related complications and blood transfusion requirement, which often harness the postoperative outcomes of TAVR patients, especially in those unsuitable for TF approaches. Avoidance of chest incision and ventricular puncture in combination with the possibility of a direct access to the aorta through a rapidly healing and relatively pain-free entry site might render the transcervical approach a valid alternative for non-TF candidates. The ease for recovery after the operation might also reinforce the prospect to transform TAVR in a same-day or next-day discharge procedure. Further experience with this technique is warranted.
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