LAUSR

Background and Aim: Trans-carotid access with loco-regional anesthesia has been developped as peripheral approach for transcatheter aortic valve implantation (TAVI) in alternative to transthoracic more invasive accesses for patients with transfemoral contraindications, high vascular risk and severe comorbidities. In this study, we report our experience and mid-term results in trans-carotid TAVI under loco-regional anesthesia by cervical block. Methods: Thirty patients were selected by the Heart Team of our institution for trans-carotid TAVI between September 2014 and December 2017. Mean age was 83.6 ± 6, 9 years old. the Logistic EuroSCORE was 21,7 ± 12,2, EuroSCORE 2 was 7.7 ± 5,2 and STS Score was 21,1 ± 8,8. The carotid approach was performed through a small low longitudinal cervicotomy with loco-regional anaesthesia by cervical block. Results: The transcatheter Edwards SAPIEN 3 valves (Edwards Lifesciences, Irvine, California) (n = 27; 90%) and the Medtronic Corvalve Evolut R (Medtronic, Inc., Mineapolis, Minnesota) (n = 3;10%) were used. All patients were successfully implanted. Two procedural not-access related deaths were registered, no vascular access complications occurred. There was one in-hospital minor stroke. Two patients required a pacemaker implantation for atrioventricular block. Post-operative echocardiogram showed satisfactory transvalvular gradients without significant paravalvular leak. At late follow-up (mean 12,3 ± 9,2 months) two non-cardiac deaths and one major stroke were registered and functional NYHA class improved. Conclusions: Carotid artery access for TAVI is a safe and feasible access compared to trans-apical and trans-aortic approaches. It can be realized under loco-regional anaesthesia with continuous clinical monitoring of neurological status. This approach should be considered a valid alternative for TAVI in patients with unfavourable vascular access.