Transcarotid aortic valve-in-valve implantation for degenerated stentless aortic root conduits with severe regurgitation: a case series

Publication

Transcarotid aortic valve-in-valve implantation for degenerated stentless aortic root conduits with severe regurgitation: a case series

Journal Paper/Review - Mar 15, 2015

Huber Christoph, Windecker Stephan, Englberger Lars, Carrel Thierry, Meier Bernhard, von Allmen Regula, Stortecky Stefan, Gloekler Steffen, Langhammer Bettina, O'Sullivan Crochan J, Praz Fabien, Wenaweser Peter

Citation

Huber C, Windecker S, Englberger L, Carrel T, Meier B, von Allmen R, Stortecky S, Gloekler S, Langhammer B, O'Sullivan C, Praz F, Wenaweser P. Transcarotid aortic valve-in-valve implantation for degenerated stentless aortic root conduits with severe regurgitation: a case series. Interact Cardiovasc Thorac Surg 2015; 20:694-700.

Type

Journal Paper/Review (English)

Journal

Interact Cardiovasc Thorac Surg 2015; 20

Publication Date

Mar 15, 2015

Issn Electronic

1569-9285

Pages

694-700

Brief description/objective

OBJECTIVES
Transcatheter aortic valve implantation (TAVI) is routinely performed via the transfemoral and the transapical route. Subclavian and direct aortic access are described alternatives for TAVI. Recently, the transcarotid approach has been shown to be feasible among patients with limited vascular access and severe native aortic valve stenosis. We aim to investigate the feasibility of transcatheter aortic valve-in-valve implantation via the transcarotid access in patients with severe aortic regurgitation due to degenerated stentless Shelhigh conduits using the 29 mm Medtronic CoreValve bioprosthesis.

METHODS
Three patients with complex vascular anatomy undergoing transcatheter valve-in-valve implantation via the transcarotid route were enrolled in the study. The procedure was performed under general anaesthesia using surgical cut-down to facilitate vascular access. Immediate procedural results as well as echocardiographic and clinical outcomes after 30 days and 6 months of the follow-up were recorded and analysed.

RESULTS
All three patients underwent unproblematic TAVI and experienced dramatic improvement of symptoms. Mean transvalvular gradient was 3, 6 and 11 mmHg, respectively. Effective orifice area ranged between 1.7 and 2.2 cm(2). Only mild paravalvular regurgitation was detected by echocardiography after 30 days of the follow-up.

CONCLUSIONS
The transcarotid approach can be safely performed for valve-in-valve procedures using the Medtronic CoreValve in patients with limited vascular access. It enables accurate positioning and implantation of the prosthesis.