1. 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
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CRT
Washington DC
February 23, 2015 1

2. Disclosures
Nothing to disclose
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3. 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
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4. Approaches Source XT Registry
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5. 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
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6. Transcarotid TAVR Concept Cerebral Bypass Circuit
SHUNT
SHEATH
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7. EMORY
Transcarotid TAVR

8. EMORY
Transcarotid TAVR

9. EMORY
Transcarotid TAVR

10. Transcarotid TAVR Easy Access Hemodynamically Tolerated
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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

11. EMORY
Transcarotid TAVR

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

13. Conclusions
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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

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