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Combined carotid endarterectomy and transcatheter aortic valve replacement: Technique and outcomes

Robert J Moraca1, Anil A Shah1, Stephen H Bailey1

  • 1Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.

Journal of Cardiac Surgery
|April 18, 2018
PubMed

Insights

Combined carotid endarterectomy (CEA) and transcatheter aortic valve replacement (TAVR) is safe for patients with severe aortic and carotid stenosis. This combined procedure showed no strokes or deaths at 30 days.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Stroke and transient ischemic attack (TIA) after transcatheter aortic valve replacement (TAVR) significantly increase morbidity and mortality.
  • Severe carotid artery disease is a potential contributing factor to this heightened risk.
  • This study reports the technique and outcomes of combining carotid endarterectomy (CEA) with TAVR.

Purpose of the Study:

  • To evaluate the safety and efficacy of performing CEA and TAVR concomitantly.
  • To assess the risk of cerebrovascular events and mortality in patients undergoing combined procedures.
  • To determine if this combined approach reduces the risk of stroke associated with TAVR.

Main Methods:

  • A retrospective review of 16 patients who underwent concomitant CEA/TAVR for severe aortic and carotid stenosis between March 2013 and November 2017.
  • Assessment of patient risk using the Society of Thoracic Surgeons (STS) Risk Score.
  • Analysis of outcomes including cerebrovascular events, mortality, and length of stay.

Main Results:

  • Sixteen patients with severe aortic stenosis and severe carotid artery stenosis underwent combined CEA/TAVR.
  • The mean STS Risk Score was 7.0 ± 4.7.
  • No cerebrovascular events or mortalities were observed at 30 days post-procedure. The mean length of stay was 6.4 ± 3.7 days.

Conclusions:

  • Concomitant CEA and TAVR can be safely performed in selected patients with severe aortic and carotid stenosis.
  • This combined approach does not appear to increase the risk of complications.
  • The strategy may effectively mitigate the risk of stroke in patients undergoing TAVR with concurrent severe carotid artery disease.
Abstract

Keywords:
transcatheter aortic valve replacementaortic stenosiscarotid endarterectomyvalve repair/replacement

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