Chirurgie Cardiaque Vasculaire et transplantation, Université de Lorraine, CHRU Brabois, Vandoeuvre-lès-Nancy, France.
Département de pathologie cardiaque, Institut Mutualiste Montsouris, Paris, France.
Eur J Cardiothorac Surg. 2018 Jan 1;53(1):157-161. doi: 10.1093/ejcts/ezx264.
Transcatheter aortic valve implantation is a well-recognized treatment option for high-risk patients with aortic stenosis. The femoral approach is possible in 80% of cases and remains the access of choice. When this approach is not feasible, other alternative routes have been proposed such as transapical, transaortic and subclavian. Transcarotid aortic valve implantation has been proposed as another direct vascular access. Its use is relatively new and still under evaluation.
We successfully performed transcarotid aortic valve implantation in 145 consecutive patients through the left or right carotid artery in 3 different French sites over a 2-year period. Data were prospectively entered in the French transcatheter aortic valve implantation database.
The mean age was 79.8 ± 8.7 years, with a mean logistic EuroSCORE of 20.7 ± 12.6%. The procedure was successful in all patients, and no conversion was necessary. Thirty-day survival was 93.7%, 8 (5.5%) patients presented either minor or major strokes and 1 patient had a localized asymptomatic carotid dissection. All patients were immediately extubated, and none presented respiratory complications.
Transcarotid aortic valve implantation is a safe alternative to transfemoral transcatheter aortic valve implantation, with direct access to the aortic valve, which can be performed with limited incision.
经导管主动脉瓣植入术是一种公认的治疗高危主动脉瓣狭窄患者的方法。80%的病例可采用股动脉入路，且股动脉入路仍然是首选入路。当股动脉入路不可行时，已经提出了其他替代途径，如经心尖、经主动脉和锁骨下动脉。经颈动脉主动脉瓣植入术已被提议作为另一种直接血管入路。其使用相对较新，仍在评估中。
在 2 年期间，我们在 3 个不同的法国部位通过左或右颈动脉成功地为 145 例连续患者进行了经颈动脉主动脉瓣植入术。数据前瞻性地输入法国经导管主动脉瓣植入数据库。
平均年龄为 79.8±8.7 岁，平均逻辑 EuroSCORE 为 20.7±12.6%。所有患者的手术均成功，无需转换。30 天生存率为 93.7%，8 例（5.5%）患者出现轻微或中度卒中，1 例患者出现局部无症状颈动脉夹层。所有患者均立即拔管，无呼吸并发症。
经颈动脉主动脉瓣植入术是经股动脉经导管主动脉瓣植入术的一种安全替代方法，可直接进入主动脉瓣，切口有限。
