title: Transcatheter aortic valve implantation using the left transcarotid approach in patients with previous ipsilateral carotid endarterectomy.
abstract: OBJECTIVE
  To assess the feasibility and safety of transcatheter aortic valve implantation (TAVI) through a left transcarotid approach in patients previously operated on for ipsilateral carotid endarterectomy (CEA).
  
  
  BACKGROUND
  The healthcare impact of extracranial carotid artery disease is essential as stroke is the third-leading cause of death in industrialized nations and CEA is often present in the history of patients awaiting TAVI.
  
  
  METHODS
  The primary endpoint was to evaluate 30-day mortality and freedom from major TAVI-related complications in an observational analysis.
  
  
  RESULTS
  From December 2011 to February 2014, we performed 9 TAVI. The mean age was 84.6 years. The procedure was performed without any technical complication or vascular injury in every patient. There was neither intraoperative mortality nor intraoperative major complications. One (11.1%) patient experienced spatial-temporal disorientation but cerebral computed tomography did not show any sign of stroke. Two (22.2%) patients needed the implantation of a pacemaker due to third-degree atrioventricular block appearance. Three (33.3%) patients were transfused with packed red blood cells and 1 (11.1%) patient developed a groin hematoma. Only 1 (11.1%) patient showed a residual paravalvular regurgitation ≥ 2. At 30-day follow-up there was neither mortality nor other TAVI-related complications and echocardiography parameters remained stable.
  
  
  CONCLUSIONS
  TAVI through a left transcarotid approach in patients previously operated on for ipsilateral CEA is feasible and safe. The presence of a previous ipsilateral CEA represents no more a limitation to the utilization of this promising access route. At short-term follow-up, mortality and major complications rates are low.
authors.affiliation: Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pozzi
authors.affiliation: Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grinberg
authors.affiliation: Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Obadia
authors.affiliation: Department of Anesthesia-Reanimation, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Saroul
authors.affiliation: Department of Interventional Cardiology, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France.
authors.forename: Lisa
authors.initials: L
authors.lastname: Green
authors.affiliation: Department of Interventional Cardiology, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Dementhon
authors.affiliation: Department of Interventional Cardiology, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pizzighini
authors.affiliation: Department of Interventional Cardiology, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rioufol
authors.affiliation: Department of Interventional Cardiology, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Finet
authors.affiliation: Department of Cardiothoracic Surgery, Cardiologic University Hospital, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002340:Carotid Artery Diseases / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005602:France; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic valve stenosis; common carotid artery; thromboendarterectomy