title: Transcarotid aortic valve-in-valve implantation for degenerated stentless aortic root conduits with severe regurgitation: a case series.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is routinely performed via the transfemoral and the transapical route. Subclavian and direct aortic access are described alternatives for TAVI. Recently, the transcarotid approach has been shown to be feasible among patients with limited vascular access and severe native aortic valve stenosis. We aim to investigate the feasibility of transcatheter aortic valve-in-valve implantation via the transcarotid access in patients with severe aortic regurgitation due to degenerated stentless Shelhigh conduits using the 29 mm Medtronic CoreValve bioprosthesis.
  
  
  METHODS
  Three patients with complex vascular anatomy undergoing transcatheter valve-in-valve implantation via the transcarotid route were enrolled in the study. The procedure was performed under general anaesthesia using surgical cut-down to facilitate vascular access. Immediate procedural results as well as echocardiographic and clinical outcomes after 30 days and 6 months of the follow-up were recorded and analysed.
  
  
  RESULTS
  All three patients underwent unproblematic TAVI and experienced dramatic improvement of symptoms. Mean transvalvular gradient was 3, 6 and 11 mmHg, respectively. Effective orifice area ranged between 1.7 and 2.2 cm(2). Only mild paravalvular regurgitation was detected by echocardiography after 30 days of the follow-up.
  
  
  CONCLUSIONS
  The transcarotid approach can be safely performed for valve-in-valve procedures using the Medtronic CoreValve in patients with limited vascular access. It enables accurate positioning and implantation of the prosthesis.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland christoph.huber@insel.ch huberch@gmail.com.
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Fabien
authors.initials: F
authors.lastname: Praz
authors.affiliation: Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Crochan J
authors.initials: CJ
authors.lastname: O'Sullivan
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Bettina
authors.initials: B
authors.lastname: Langhammer
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Regula S
authors.initials: RS
authors.lastname: von Allmen
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland.
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D018618:Echocardiography, Doppler, Color; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aortic regurgitation; Transcatheter aortic valve implantation; Valve-in-valve; Valvular heart disease