Transcarotid vascular access for transcatheter aortic valve implantation: is choosing the left side always right?
Details
Serval ID
serval:BIB_A49C6B76A758
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Transcarotid vascular access for transcatheter aortic valve implantation: is choosing the left side always right?
Journal
Journal of cardiothoracic surgery
ISSN
1749-8090 (Electronic)
ISSN-L
1749-8090
Publication state
Published
Issued date
10/04/2024
Peer-reviewed
Oui
Volume
19
Number
1
Pages
196
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
The transcarotid (TC) vascular access for transcatheter aortic valve implantation (TAVI) has emerged as the first-choice alternative to the transfemoral access, in patients unsuitable for the latter. The use of both the left and right common carotid arteries (CCAs) for TC-TAVI has been described, but the optimal side is subject to debate. We conducted this pilot study to compare the level of vessel tortuosity and plaque burden from either the left CCA to the aortic annulus, or the right CCA to the aortic annulus, considering them as surrogates for technical and procedural complexity.
Consecutive patients who underwent TC-TAVI between 2018 and 2021 in our institution were included. Using three-dimensional reconstruction, pre-TAVI neck and chest computed tomography angiography exams were reviewed to assess the tortuosity index (TI), sum of angles metric, as well as plaque burden, between each CCA and the aortic annulus.
We included 46 patients who underwent TC-TAVI. No significant difference regarding the mean TIs between the left and right sides (respectively 1.20 and 1.19, p = 0.82), the mean sum of angles (left side: 396°, right side: 384°, p = 0.27), and arterial plaque burden (arterial plaque found in 30% of left CCAs and 45% of right CCAs, p = 0.19) was found.
We found no convincing data favoring the use of one particular access side over the other one. The choice of the CCA side in TC-TAVI should to be made on a case-by-case basis, in a multidisciplinary fashion, and may also depend on the operators' experience.
Consecutive patients who underwent TC-TAVI between 2018 and 2021 in our institution were included. Using three-dimensional reconstruction, pre-TAVI neck and chest computed tomography angiography exams were reviewed to assess the tortuosity index (TI), sum of angles metric, as well as plaque burden, between each CCA and the aortic annulus.
We included 46 patients who underwent TC-TAVI. No significant difference regarding the mean TIs between the left and right sides (respectively 1.20 and 1.19, p = 0.82), the mean sum of angles (left side: 396°, right side: 384°, p = 0.27), and arterial plaque burden (arterial plaque found in 30% of left CCAs and 45% of right CCAs, p = 0.19) was found.
We found no convincing data favoring the use of one particular access side over the other one. The choice of the CCA side in TC-TAVI should to be made on a case-by-case basis, in a multidisciplinary fashion, and may also depend on the operators' experience.
Keywords
Humans, Transcatheter Aortic Valve Replacement/adverse effects, Transcatheter Aortic Valve Replacement/methods, Aortic Valve/diagnostic imaging, Aortic Valve/surgery, Aortic Valve Stenosis/surgery, Aortic Valve Stenosis/etiology, Pilot Projects, Carotid Artery, Common/surgery, Treatment Outcome, Computational vascular modeling, TAVI, TAVR, Transcarotid, Vascular access, Vessel tortuosity
Pubmed
Web of science
Open Access
Yes
Create date
11/04/2024 10:03
Last modification date
09/08/2024 16:04