TAVR The Transcarotid Approach Christian Shults MD Cardiac

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 CRT Washington DC February 23, 2015 EMORY

Disclosures • Nothing to disclose EMORY

The Battle of Alternative Access • Transfemoral TAVR least morbid procedure • Trans. Apical, Trans. Aortic, Trans. Axillary, Trans. Caval • There are limitations to all approaches • Experienced TAVR centers have a tailored approach • Trans. Carotid TAVR is a viable alternative EMORY

Approaches Source XT Registry EMORY

Patients Selected for Trans. Carotid 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

Transcarotid TAVR EMORY

Transcarotid TAVR EMORY

Transcarotid TAVR 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

Emory Transcarotid TAVR Experience 30 - day outcomes Success 30 day Mortality Bleeding Vascular Complications Renal Failure PVL > Grade 1 Clinical Stroke EMORY N=14 100% 0 0 0

Conclusions • 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 EMORY

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