Eastern Cardiothoracic Surgical Society

Concomitant Carotid Endarterectomy and Transcatheter Aortic Valve Replacement Technique and  Outcomes
Robert J. Moraca, Harper L. Padolsky, Anil A. Shah, Stephen H. Bailey, Diane Berger, George Magovern, Jr.,
Daniel Benckart,  Allegheny General Hospital, Pittsburgh, PA

OBJECTIVE: Stroke is a devastating and multifactorial complication after transcatheter aortic valve replacement (TAVR) for patients with severe aortic stenosis. One key correctable risk factor for a neurological event is severe carotid stenosis. In this series we review the technique and outcomes of concomitant carotid endarterectomy and transcatheter aortic valve replacement CEA/TAVR.

METHODS: We reviewed the all patients at a single institution through December 2012 through May 2016 who underwent a concomitant CEA/TAVR. Prospectively collected demographic, clinical and outcome data were reviewed and surgical techniques are described.

RESULTS: There were 458 patinets who underwent TAVR at a single institution of which 11 patients underwent successful concomitant CEA/TAVR procedures for severe carotid and severe aortic stenosis. 54.5% (n=6) of patients were male with a mean age of 82.6 years (range 72-92 years). The mean Society of Thoracic Surgeons (STS) Risk Score was 7.29 ( ±4.02). All patients had severe carotid stenosis as identified by carotid duplex imaging and confirmed by computed tomography angiography (CTA). The mean length of stay was 4.5 days (range 2-11 days). 30 day mortality was 0% and there were no postoperative neurological events (Table SA7-1).

CONCLUSIONS:  We report the first series of concomitant CEA /TAVR with severe critical aortic stenosis and severe carotid stenosis. The combined approach may potentially reduce the risk of postoperative stroke in this subgroup of high risk patients.

Table SA7-1. Patient Outcomes of Concomitant CEA/TAVR (n=11)

Median Length of Stay

(Range 2-11 days)

4.5 Days
Hospital Mortality 0% (n=0)
30 day Mortality 0% (n=0)
Neck Hematoma 9.1% (n=1)
Stroke 0% (n=0)
Respiratory Failure 0% (n=0)
GI Bleed 9.1% (n=1)
CHF 0% (n=0)
Bradycardia 9.1% (n=1)
Tachycardia 9.1% (n=1)