Descripción técnica y resultados del implante transcatéter valvular aórtico transcarotídeo. Experiencia de nuestro centro

Introduction

Transcatheter aortic valve implantation is the first-line technique in patients older than 75 years. The transfemoral access is the more frequently used, but 15% to 20% of patients have severe peripheral vascular disease, which precludes its use. As an alternative, the axillary route is used and recently the carotid route.

In this paper we present our experience, describe our technique, and report our results with a follow up of 40 months maximum and mean (8,32 ± 10,12 months).

Material and methods

25 patients were operated on during this interval (January 2020-June 2023), 84% men, age 78.88 ± 6.3, 100% hypertensive and with significant peripheral arterial disease, STS score 4.46 ± 0.87, 80% dyslipidemic, 60% NYHA III-IV, 44% chronic renal failure, 80% chronic ischemic heart disease, 28% previous stroke, COPD 48%, 16% patent left internal mammary bypass, and 24% of previous cardiac surgery. The prostheses used were Sapien 3 (36%), Portico-Navitor (60%) and Accurate Neo (4%).

Results

Mortality at 30 days 4%, at one year 9%, AVC 4%, AMI 4%. Implant success 100%, pacemaker implantation 12%. We did not obtain CRF exacerbation, major or minor bleeding, perforation of LV or pericardial effusion, malpositioning or implantation of more than one prosthesis, or coronary obstruction. More than mild periprosthetic insufficiency was 4%.

Conclusions

The transcarotid transcatheter implantation is feasible, with good results, to take into account its use when the femoral and axillary accesses are not suitable.