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Published on: June 3, 2018
Extracorporeal Femoro-Carotid Shunt for Transcarotid Transcatheter Aortic Valve Replacement
Robert Semco1, Ross G McFall2, Jay Khambhati3
1Harvard Medical School, Boston, Massachusetts, USA.
Insights
Transcatheter aortic valve replacement (TAVR) can be done via a transcarotid route if transfemoral access is not possible. A temporary shunt enabled successful TAVR in a patient experiencing electroencephalographic changes during the procedure.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement for severe aortic stenosis.
- Transfemoral access is the standard TAVR approach, but peripheral vascular disease can preclude its use.
- The transcarotid approach offers an alternative route for TAVR when transfemoral access is not feasible.
Observation:
- A patient with severe aortic stenosis presented in cardiogenic shock.
- Electroencephalographic (EEG) changes were noted during a transcarotid TAVR procedure.
- These changes suggested potential cerebral hypoperfusion or embolic events.
Findings:
- A temporary extracorporeal femoro-carotid shunt was implemented during the transcarotid TAVR.
- The shunt successfully maintained cerebral perfusion and facilitated the completion of the TAVR procedure.
- Hemodynamic stability and neurological status improved post-procedure.
Implications:
- Temporary extracorporeal shunting is a viable strategy to manage intraprocedural complications during transcarotid TAVR.
- This technique may improve outcomes for high-risk patients undergoing TAVR via alternative access routes.
- Further research is warranted to evaluate the safety and efficacy of femoro-carotid shunts in TAVR.
Abstract:
Transcatheter aortic valve replacement may be performed with a transcarotid approach when peripheral vascular disease is prohibitive for transfemoral access. In this case, a patient who presented in cardiogenic shock secondary to severe aortic stenosis developed electroencephalographic changes during transcarotid TAVR. A temporary extracorporeal femoro-carotid shunt permitted successful TAVR.
