title: Transcatheter aortic valve implantation through a transcarotid approach under local anesthesia.
abstract: OBJECTIVE
  We report the first experience of transcatheter aortic valve implantation through a transcarotid approach under local anesthesia.
  
  
  RESULTS
  An 81-year-old gentleman with severe symptomatic aortic stenosis was referred for TAVI. He was not suitable for transfemoral, transapical, subclavian, or direct aortic approach. He had severe lung disease and was considered unsuitable for general anesthesia. We, therefore, performed the procedure under local anesthesia though the right common carotid artery (CCA) approach. Superficial cervical block was achieved with Levobupivacaine, and in addition, he also had a target controlled infusion of Remifentanil. Cerebral oximetry was monitored throughout the procedure. The CCA was accessed through surgical cut-down. Aortic valvuloplasty was performed through a 12-F sheath, and the CoreValve was deployed successfully through an 18-F sheath.
  
  
  CONCLUSIONS
  TAVI is commonly performed through femoral access under local anesthesia. The right carotid artery approach under local anesthesia requires careful monitoring of cerebral oxygen levels but allowed us to perform successful TAVI in this high risk patient when all conventional approaches were contra-indicated. Compared with a right subclavian or left carotid access, the right carotid offers more direct angle of approach allowing precise valve placement with minimal readjustment during deployment.
authors.affiliation: Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Blackpool, United Kingdom.
authors.forename: Rajinikanth
authors.initials: R
authors.lastname: Rajagopal
authors.forename: Ranjit S
authors.initials: RS
authors.lastname: More
authors.forename: David H
authors.initials: DH
authors.lastname: Roberts
mesh_terms: D000369:Aged, 80 and over; D000701:Analgesics, Opioid; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001027:Aortography / Q000379:methods; D002045:Bupivacaine / Q000031:analogs & derivatives; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D000077554:Levobupivacaine; D018810:Magnetic Resonance Angiography; D008297:Male; D009407:Nerve Block; D010092:Oximetry; D010880:Piperidines; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D000077208:Remifentanil; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010880:Piperidines; D000077554:Levobupivacaine; D000077208:Remifentanil; D002045:Bupivacaine
keywords: TAVI; aortic stenosis; carotid artery; cerebral oximetry; contraindication; general anesthesia; local anesthesia; peripheral vascular disease