Tavi Through the Carotid Artery Access Under Local Anesthesia /A Series of 50 Patients/

Objective: Transfemoral is the most commonly used access for TAVI. When this approach is unsuitable alternative accesses are needed. We report of 50 consecutive patients undergoing TAVI through common carotid artery (CCA) access mostly under local anaesthesia. Methods: From March 2010 to October 2013, 50 patients mean age: 82.1±6.6 years, Euro-SCORE:22.1±15.1, STS-Score:12.1±5.2 were unsuitable for usual approaches and underwent TAVI through the CCA access, most of the cases under local anaesthesia. Pre-operative MS-CT and angiography assessed suitable CCA anatomy. CCA cross-clamping test allowed verifying clinical patient’s neurological status stability. An 8 mm Dacron-Conduit for the 16- 18-Fr. catheter was inserted onto the CCA as access down into the ascending aorta. TA-Valve implantation procedures were as usual. After catheter removal, CCA was surgically purge &, repaired. Feasibility & safety endpoints (VARC-2) were collected up to 30 days. Results: Transcarotid valve delivery and accurate deployment was successful in all cases (100 %; 13 right, 37 left; 36 Edwards SAPIEN XT® and 12 Medtronic CoreValve®). There was one intra-operative death by aortic annulus rupture during pre-implant balloon valvuloplasty and one in-hospital death due to multisystem organ failure. There was no myocardial infarction, stroke, TIA or major bleeding. No vascular access-site, access-related or pulmonary, kidney complication occurred. Third-degree atrioventricular block requiring pacemaker implantation occurred in 5 patients (10 %). Post-op. echocardiography control assessed good prosthesis’ position in all patients. There were none, mild and moderate paravalvular leak in respectively: 33, 16 and one (66%; 33%; 0,5%) patients. Patient ambulation was immediate after TAVI and hospital stay was 4.2 ± 2.3 days. Conclusions: TAVI through CCA approach under local anaesthesia seems feasible and safe. This access allows continuous neurologic status monitoring with low risk of stroke, bleeding events, vascular access-related & pulmonary-kidney complications. It appears to be a valuable & less invasive alternative access for patients who cannot undergo transfemoral TAVI