Transcarotid Approach for Transfemoral in TAVR

Courtesy of Dr. Carlos Fava.

At present, the transfemoral is the preferred access site in TAVR, for it has been shown to present fewer complications. However, whenever not feasible, we can resort to other approaches. These include the subclavian, the transapical, the transcaval, the transaortic, and the transcarotid.

This last one has been studied few times, and always with the CoreValve. There is scarce information on this approach with the use of the Edwards Sapien 3 valve.

The French registry included 6680 patients. 314 of these cases (4.7%) received transcarotid TAVR with the Edwards Sapien 3 valve.

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Mean age was 83, most were men, 26.8% were diabetic, 64% had peripheral vascular disease, 18.2% had prior infarction, 39.2% prior PCI, 20.1% prior CABG, most were class III-IV, 34% had atrial fibrillation, 32.2% kidney function deterioration and ejection fraction was 55%. STS was 5.8%, Euroscore II 5.7% and Euroscore I 18.8%.

The procedure was done under general anesthesia in 97% of patients. The left carotid artery was used in 73.6% and procedural success rate was 97%. Three patients died of annulus rupture and other two were converted to surgery for excessive carotid tortuosity.

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AT 30 days, mortality rate was 3.2%, major bleeding 4.1%, stroke or transient ischemic attack 1.6%, and need for pacemaker implantation 16%.

Conclusion

In this multicenter, prospective study, transcarotid TAVR with Edwards Sapien 3 was safe and effective. The transcarotid access in TAVR could be considered as first choice in a select group of patients instead of the transfemoral approach, whenever the latter were not feasible. The Edwards Sapien 3 was safe and effective in this multicenter cohort.  

Gentileza del Dr. Carlos Fava.

Original title: Transcarotid Approach for Transcatheter Aortic Valve Replacement with the Sapien 3 Prosthesis.

Reference: Pavel Overtchouk, et al. J Am Coll Cardiol Intv 2019; article in press.

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