Transcarotid approach for TAVI: an optimal alternative to the transfemoral gold standard

An 84-year-old male was addressed to our institution for degenerative stenosis of the aortic Carpentier-Edwards PERIMOUNT bioprosthesis (Edwards Lifesciences, Irvine, CA, USA). Transcatheter aortic valve implantation (TAVI) was favored to open surgery by the Heart Team because of patient’s age, overweight (body mass index 31 kg/m2), smoking, a history of moderate chronic renal failure [creatinine clearance with Modification of Diet in Renal Disease (MDRD) formula: 42 mL/min/1.73 m2], coronary artery disease, and a high STS score of 12.2%. The preoperative coronary angiography showed no lesion; however aortic multidetector computed-tomography identified obstructive bilateral ilio-femoral arteriopathy that precluded trans-femoral pathway. Thus, the minimally invasive left trans-carotid access was deemed the most appropriate access for TAVI