International Society For Minimally Invasive Cardiothoracic Surgery

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Results Of Transcatheter Aortic Valve Implantation By Trans-carotid Approach Under Loco-regional Anaesthesia. Single Center Experience
Maud-Emmanuelle OLIVIER, Jr..
Division of Cardiovascular and Thoracic Surgery, Robert Debré University Hospital, Reims, France, REIMS, France.

Background: Even if transfemoral represents the optimal access for transcatheter aortic valve implantation (TAVI). Trans-carotid access allows a more direct and easy vascular access. It doesn’t need for general anaesthesia. In this study, we report our experience and mid-term results in trans-carotid TAVI realized under loco-regional by cervical block. Method: Fifty patients underwent TAVI via carotid artery at our institution, since September 2014 to December 2018. Mean age was 83.1±7,5 years old. The choice for Carotid artery access was achieved by heart team after clinical and CT images screening. The carotid approach was performed through a small low longitudinal cervicotomy after loco-regional anaesthesia by cervical block. The valve Academic Research Consorsium-2 (VARC-2) criteria was used to define the procedural feasibility, device success and post-operative outcomes. Results:The transcatheter heart valves Edwards SAPIEN 3® (Edwards Lifesciences, Irvine, California) (n= 47; 94%) and the Medtronic Corvalve®/Evolut R (Medtronic, Inc., Mineapolis, Minnesota) (n= 3; 6%) were used. All patients were successfully implanted. Three procedurals not-access related deaths were registered, no vascular access complications. There was one minor stroke (TIA) and one stroke post during hospitalisation. Post-operative control echocardiographic showed a satisfactory transvalvular gradient.Follow-up (mean 13,1 ±12,4 months) was complete. One stroke was noticed at two months after the intervention. Conclusion: Carotid artery access for TAVI had to be considered as a safe and feasible access. Common carotid artery often offers a larger vascular diameter. Moreover carotid approach can be realized under loco-regional anaesthesia with continuous clinical monitoring of neurological status.We believe that carotid approach should be considered as first alternatives in patients with unfavourable femoral access for TAVI. Abstract Words count: 270 Words. Key words: transcatheter aortic valve implantation (TAVI), aortic valve stenosis, trans-carotid access

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