Transcutaneous aortic valve implantation using the carotid artery access: Feasibility and clinical outcomes

Kallinikou, Zacharenia; Berger, Alexandre; Ruchat, Patrick; Khatchatourov, Gregory; Fleisch, Isabelle; Korkodelovic, Branislav; Henchoz, Emmanuel; Marti, René-Andréas; Cook, Stéphane; Togni, Mario; Goy, Jean-Jacques

doi:10.1016/j.acvd.2016.10.005

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Journal article

Transcutaneous aortic valve implantation using the carotid artery access: Feasibility and clinical outcomes

Kallinikou, Zacharenia Department of Cardiology, University of Fribourg and Hospital of Fribourg, Switzerland
Berger, Alexandre Clinique Cecil, Lausanne, Switzerland
Ruchat, Patrick Clinique Cecil, Lausanne, Switzerland
Khatchatourov, Gregory Clinique Cecil, Lausanne, Switzerland
Fleisch, Isabelle Clinique Cecil, Lausanne, Switzerland
Korkodelovic, Branislav Clinique Cecil, Lausanne, Switzerland
Henchoz, Emmanuel Clinique Cecil, Lausanne, Switzerland
Marti, René-Andréas Clinique Cecil, Lausanne, Switzerland
Cook, Stéphane Department of Cardiology, University of Fribourg and Hospital of Fribourg, Switzerland - Clinique Cecil, Lausanne, Switzerland
Togni, Mario Department of Cardiology, University of Fribourg and Hospital of Fribourg, Switzerland - Clinique Cecil, Lausanne, Switzerland
Goy, Jean-Jacques Department of Cardiology, University of Fribourg and Hospital of Fribourg, Switzerland - Clinique Cecil, Lausanne, Switzerland

01.06.2017

Published in:

Archives of Cardiovascular Diseases. - 2017, vol. 110, no. 6, p. 389–394

English Background: Transcarotid access is an alternative route for transcutaneous aortic valve implantation (TAVI) in patients with impossible transfemoral access.Aims: We evaluated the safety, effectiveness and early and late clinical outcomes of CoreValve® implantation via the common carotid artery.Methods: Eighteen patients (10 men, 8 women; mean age 84 ± 5 years) at high surgical risk (mean EuroSCORE II 16 ± 13%) with significant peripheral artery disease underwent TAVI via common carotid artery access under general anaesthesia. Mean aortic valve area was 0.64 ± 0.13 cm2 (0.36 ± 0.07 cm2/m2).Results: At a mean follow-up of 605 ± 352 days, two patients (11%) had died in hospital, on days 6 and 20, as a result of sepsis with multiorgan failure (n = 1) or pneumonia (n = 1). There were no perioperative deaths, myocardial infarctions or strokes. Perioperative prosthesis embolization occurred in one patient (6%), requiring implantation of a second valve. In-hospital complications occurred in four patients (23%): blood transfusion for transient significant bleeding at the access site in one patient (6%); permanent pacemaker implantation in two patients (11%); and pericardial drainage in one patient (6%). The rate of event-free in-hospital stay was 66%. Post-procedural echocardiography showed very good haemodynamic performance, with a mean gradient of 8 ± 3 mmHg. Moderate paravalvular leak was present in one patient (6%). Mean intensive care unit stay was 48 ± 31 h; mean in- hospital stay was 7 ± 3 days.Conclusion: TAVI performed by transcarotid access in this small series of severely ill patients was associated with a low incidence of complications, which were associated with the procedure itself rather than the access route.

Faculty

Faculté des sciences et de médecine

Department

Médecine 3ème année

Language