Percutaneous access and closure in transcarotid aortic valve implantation using a collagen vascular plug

A73-year-old male presented to our hospital with symptoms of severe heart failure. The history revealed chest radiotherapy for lymphoma, ischaemic stroke, atrial fibrillation, and implantable cardioverter-defibrillator implantation for primary prevention. Echocardiography confirmed severe, bicuspid Sievers type 1 aortic valve stenosis. Computed tomography (CT) and vascular ultrasound revealed bilateral severe stenoses of the iliac arteries with patent carotid access without wall calcifications or jugular vein overlap (Figure 1A). After the Heart Team assessed the optimal vascular access, the patient was qualified for a transcarotid transcatheter aortic valve implantation (TAVI) using the SAPIEN 3 Ultra and Commander delivery system (Edwards Lifesciences).

The left common carotid artery was punctured under general anaesthesia and vascular ultrasound monitoring. The MANTA vascular closure device depth locator (Teleflex) was used to determine the skin-to-carotid artery distance for subsequent insertion of a 14 Fr eSheath. The SAPIEN 3 Ultra 26 mm valve was implanted with left ventricular pacing using a cusp-overlap fluoroscopy view to ensure full bioprosthesis expansion. Following protamine administration and removal of the TAVI system, the operator inserted the MANTA delivery sheath into the carotid...