Document Detail


Transcatheter aortic valve implantation through a transcarotid approach under local anaesthesia.
MedLine Citation:
PMID:  24399743     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Aims: We report the first experience of Transcatheter Aortic Valve Implantation through a transcarotid approach under local anaesthesia Methods and 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 anaesthesia. We therefore performed the procedure under local anaesthesia 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 12F sheath and the CoreValve was deployed successfully through an 18F sheath. Conclusion: TAVI is commonly performed through femoral access under local anaesthesia. The right carotid artery approach under local anaesthesia 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. © 2013 Wiley Periodicals, Inc.
Authors:
Rajagopal R; More R S; Roberts D H
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-1-8
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-1-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Wiley Periodicals, Inc., a Wiley company.
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