[Percutaneous aortic valve replacement by trans-carotid approach: First case in Chile]

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Transcatheter aortic valve implantation (TAVI) is increasingly indicated, with transfemoral (TF) access being preferred.
• Alternative access routes are necessary when TF access is contraindicated due to anatomical or pathological reasons.
• The optimal alternative access for TAVI remains an area of ongoing investigation.

Observation:

• An 81-year-old patient with high surgical risk presented with severe aortic stenosis and a 50% obstruction of the descending aorta.
• This obstruction rendered standard transfemoral access unsuitable.
• A left transcarotid access approach was selected for TAVI.

Findings:

• The left transcarotid approach was successfully utilized for TAVI in this patient.
• This represents the first reported case of transcarotid TAVI at Las Higueras Hospital, Talcahuano, Chile.
• Clinical reviews suggest the transcarotid approach offers favorable outcomes and is a recognized second-line alternative to TF access.

Implications:

• The transcarotid approach is a feasible and effective alternative for TAVI in patients with contraindications to transfemoral access, particularly those with aortic pathologies.
• This case highlights the importance of considering less common access routes to expand TAVI eligibility.
• Further research into the comparative outcomes of various TAVI access strategies is warranted.