Transcutaneous Aortic Valve Implantation Using the Left Carotid Access: Feasibility and Early Clinical Outcomes

• Published in: The Annals of thoracic surgery Vol. 93; no. 5; pp. 1489 - 1494
• Main Authors: Modine, Thomas, MD, PhD, Sudre, Arnaud, MD, Delhaye, Cedric, MD, Fayad, Georges, MD, Lemesle, Gilles, MD, Collet, Frederic, MD, Koussa, Mohamad, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2012; Elsevier
• Subjects: Age Factors; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta; Aortic valve; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - therapy; Biological and medical sciences; Cardiac Catheterization - methods; Cardiology. Vascular system; Cardiothoracic Surgery; Carotid Arteries; Carotid artery; Catheterization; Echocardiography, Doppler; Feasibility Studies; Female; Follow-Up Studies; Geriatric Assessment; Heart; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Humans; Injuries; Male; Medical sciences; Minimally Invasive Surgical Procedures - methods; Patient Selection; Perfusion; Pneumology; Prospective Studies; Punctures; Radiography, Interventional - methods; Risk Assessment; Risk factors; Risk groups; Sheaths; Single-Blind Method; Surgery; Thorax; Transient ischemic attack; Treatment Outcome; 35; Left; Prognosis; Accessibility; Carotid; Anesthesia; Implantation; Early; Feasibility; Circulatory system; Cardiology; Aortic valve
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.01.030

Background In some patients, transfemoral, transaxillary, or transapical aortic valve implantation is not possible. Thus, carotid artery access may represent a safe alternative to those accesses, and even offers certain advantages. In this article, we describe aortic valve implantation using the left carotid arterial approach and report our initial experience. Methods Using a self-expandable nitinol based device (CoreValve ReValving system, Medtronic Ltd, Luxembourg), we exposed the left carotid artery through a small incision. Arterial puncture and initial 6F sheath introduction were achieved through a contraincision. The same implantation technique as for transaxillary implantation was used. Progressive artery dilatation was achieved using sheaths of increasing diameter. Rapid ventricular pacing was used to reduce cardiac output while performing a routine aortic balloon valvuloplasty. Only then, an 18F sheath was inserted into the carotid artery and pushed down into the ascending aorta. The patients were monitored using cerebral oxymetry to assess cerebral perfusion. Results Twelve consecutive patients, at high surgical risk, were implanted and studied prospectively. Transfemoral and subclavian catheterization were considered unfeasible or at risk of severe complications. Carotid arterial injury did not occur in any patient. A transient ischemic attack occurred in 1 patient, contralateral to the carotid access. There were no deaths in either intraprocedural or during the 30-day follow-up period. Conclusions This initial experience suggests that left carotid transarterial aortic valve implantation, in selected high-risk patients, is feasible and safe with satisfactory short-term outcomes.