Transcarotid Transcatherter Aortic Valve Implantation Combined with Traditional Both Sides
Carotid Endarterectomy is a Safe, Feasible and Low risk Procedure with Advantages

Introduction: For patients with symptomatic carotid artery stenosis even on both sides with high grade aortic valve stenosis the carotid artery access is by given nature the safest access. We would like to present here our first 5 cases with the initial expeiences and results.
Methods: We started the procedure with a right sided transcarotid endarterectomy (TEA) at the both sided stenotic patients in local anesthesia traditionally with a Dacron patch-plasty followed by the left sided TEA in a superficial narcosis. At the other four patients the access was the symptomatic and the antomical optimal left side. Thereafter an 8 mm diameter and a 6-8 cm long Dacron-Conduit "end to side" on the left common carotid artery below the TEA suture line was fixed. A self-expending Nitinol-based device (Core Valve Re-Valving System, Medtronic Inc. USA) was used without the guiding sheat. due to the differences in diameter between the common carotid artery and the 18 French catheter, the carotid artery stayed open and the brain was perfused continuously during the netire procedure. Under rapid pacing in two stages was the routine aortic baloon valvuloplasty performed. Then the 18 French aortic valve catheter was positioned into the diseased valve and expanded step-wise under fluoroscopy, EEG and brain oxymetry control.
Results: All patients had high surgical risk,(EUROSCORE:32,75%; STS
Score:27,85%) due to co-morbi-dities and post-stroke condition and all were over 70 years old. Neither carotid artery injury nor stroke occur in all patients peri-,or postoperatively. Till today there were no 30 days mor- tality and death.
Conclusion: This intial,- one, with both sided TEA is worldwide the first,-cases suggest, that in high risk patients with these two combined symptomatic diseases, the transcarotid aortic access and the aortic valve implantation combined with the traditionasl routine carotid endarterectomy even in both sides is a natural given, feasible and the safest access with satisfactory results.
This access can involve also the vascular surgery society into an experienced TAVI-TEAM.