Transcarotid TAVI: Step by Step Technique
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v2i4.2795
Abstract
Introduction and objectives: Transcatheter aortic valve implantation as a treatment for aortic stenosis is positioned as the therapy of choice for a specific population of patients, which is steadily increasing and is no longer limited to patients with prohibitively high surgical risk. This stems from the advancement and refinement of devices, as well as the development of different access routes. Our goal is to share and standardize the transcarotid access technique, which we have implemented and developed since 2019 with very good results. Method and results: Between 01/01/2019 and 31/12/2023, 79 transcatheter valves were implanted via the carotid route (21.43% of the total implants in our center), with no intraoperative mortality and less than 1% mortality during the first month of intervention. The incidence of established strokes in these patients is 0%. Conclusions: We have adopted the transcarotid route as an equally valid alternative to the transaxillary access. Due to recent changes in patient selection criteria, we believe that the cardiovascular surgeon should have an active role in decision-making and implantation of this type of prosthesis, since many patients have low surgical risk and are consequently susceptible to intervention in case of procedure complications.
Keywords
transcatheter; aortic stenosis; TAVI; transcarotid; valve
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[4] Faroux L, Junquera L, Mohammadi S, del Val D, Muntané-Carol G, Alperi A, et al. Femoral versus nonfemoral subclavian/carotid arterial access route for transcatheter aortic valve replacement: a systematic review and meta-analysis. J Am Heart Assoc. 2020;9:e017460, http://dx.doi.org/10.1161/JAHA.120.017460.
[5] Folliguet T, Laurent N, Bertram M, Zannis K, Elfarra M, Vanhuyse F, et al. Transcarotid transcatheter aortic valve implantation: multicentre experience in France. Eur J Cardiothorac Surg. 2018;53:157-61, http://dx.doi.org/10.1093/ejcts/ezx264.
[6] Modine T, Lemesle G, Azzaoui R, Sudre A. Aortic valve implantation with the CoreValve ReValving System via left carotid artery access: first case report. J Thorac Cardiovasc Surg. 2010;140:928-9, http://dx.doi.org/10.1016/j.jtcvs.2010.03.001. PMID: 20381818. Disponible en: https://www.jtcvs.org/article/S0022-5223(10)00231-X/fulltext
[7] Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al., PARTNER 3 Investigators. Transcatheter aortic-valve replacement with a balloonexpandable valve in low-risk patients. N Engl J Med. 2019;380:1695-705, http://dx.doi.org/10.1056/NEJMoa1814052.
[8] Macías Rubio D, Vignau Cano JM, Gómez Vidal MA, Daroca Martínez T. TAVI transaxilar: la técnica paso a paso. Cir Cardiov. 2018;25:186-90, http://dx.doi.org/10.1016/j.circv.2018.06.001.
[9] Registro Espanol de Hemodinámica y Cardiología Intervencionista. XXXI informe oficial de la Asociación de Cardiología Intervencionista de la Sociedad Espanola de Cardiología (1990-2021). Disponible en: https://doi.org/10.1016/j.recesp.2022.08.008.
[10] Cirugía cardiovascular en Espana en el ano 2021. Registro de intervenciones de la Sociedad Espanola de Cirugía Cardiovascular y Endovascular (RECC). Disponible en: 10.1016/j.circv.2023.04.003.
[11] Forrest J, Deeb G, Yakubov S, Gada H, Mumtaz MA, Ramlawi B, et al. 3-year outcomes after transcatheter or surgical aortic valve replacement in low-risk patients with aortic stenosis. J Am Coll Cardiol. 2023;81:1663-74, http://dx.doi.org/10.1016/j.jacc.2023.02.017.
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