TAVR – The Trans-carotid Approach Christian Shults, MD Cardiac Surgeon Structural Heart Program Complex Aortic Disease Program Medstar Heart and Vascular Institute Valve and Structural II EMORY CRT Washington DC February 23, 2015 1

Disclosures Nothing to disclose EMORY

The Battle of Alternative Access Transfemoral TAVR least morbid procedure TransApical, TransAortic, TransAxillary, TransCaval There are limitations to all approaches Experienced TAVR centers have a tailored approach TransCarotid TAVR is a viable alternative EMORY 3

Approaches Source XT Registry EMORY

Patients Selected for TransCarotid TAVR Patient #1: Moderate-Severe COPD, Porcelain, Frail, Jehovah’s Witness Patient #2: 6 previous sternotomies, Congenital Bicuspid Valve (Shone’s Comoplex), homograft failure, Severe LV dysfunction Patient #3: Severe COPD, Porcelain Aorta, Previous CABG, Severe LV dysfunction Patient #4: Severe COPD, Porcelain Aorta, Frail Patient #5: Severe COPD, Severe renal failure, Previous CABG, Frail EMORY

Transcarotid TAVR Concept Cerebral Bypass Circuit SHUNT SHEATH EMORY

EMORY Transcarotid TAVR

EMORY Transcarotid TAVR

EMORY Transcarotid TAVR

Transcarotid TAVR Easy Access Hemodynamically Tolerated EMORY Transcarotid TAVR Easy Access Hemodynamically Tolerated Good Control with Deployment Minimal Blood Loss Easy Repair (Patch) Guyton, R. et al, CCI 2012 Thourani et al, ATS, in press

EMORY Transcarotid TAVR

Emory Transcarotid TAVR Experience 30- day outcomes N=14 Success 100% 30 day Mortality Bleeding Vascular Complications Renal Failure PVL > Grade 1 Clinical Stroke

Conclusions EMORY Transcarotid TAVR is feasible as an alternative in selected patients An alternative approach: With good control for access and closure Without invasion of thorax, retroperitoneum or bleeding Further research on stroke prevention and performance under local anesthesia is required 13

Thanks Christian Shults, MD Christian.shults@medstar.net EMORY