Clampless transcarotid transcatheter aortic valve implantation

The use of transcatheter aortic valve implantation (TAVI) has become the most popular technique of aortic valve intervention. Classically, TAVI is performed via femoral arterial access. However, some patients who have severe peripheral arterial disease do not have safely accessible femoral arteries. In such patients, the use of carotid access has been well described via the 'clamp-and-sew' technique. We describe a minimally invasive carotid access technique for TAVI deployment. The right common carotid is accessed by a 3 cm suprasternal incision. The carotid sheath is entered, and the surgeon obtains proximal and distal control of the carotid artery. The surgeon then makes two opposing purse strings over the anterior surface of the carotid artery. The Seldinger technique is used to obtain access to the carotid artery, followed by placement of the TAVI sheath. The valve is then deployed and echocardiographically confirmed. Upon removal of the TAVI sheath, the purse strings are tightened and sequentially tied. Haemostasis is achieved and skin is closed. This minimally invasive TAVI technique provides an option for patients with unfavourable peripheral access sites while offering the benefits of TAVI compared to open valve replacement.