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Updated: Mar 14, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
06:04

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

Published on: August 8, 2025

676

Transaxillary versus transaortic approach for transcatheter aortic valve implantation with CoreValve Revalving

Claudia Fiorina1, Giuseppe Bruschi2, Luca Testa3

  • 1Spedali Civili Brescia, Brescia, Italy - clafiorina@yahoo.it.

The Journal of Cardiovascular Surgery
|October 5, 2016
PubMed

Insights

Transcatheter aortic valve implantation (TAVI) via the transaortic (TAo) route offers similar device success and safety compared to the transaxillary (TAx) approach. However, TAo TAVI requires specialized care due to increased risks like acute kidney injury and longer hospital stays.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Surgical Innovation

Background:

  • Severe peripheral artery disease complicates standard femoral access for transcatheter aortic valve implantation (TAVI).
  • Alternative TAVI access routes, including transaxillary (TAx) and transaortic (TAo), are crucial for patients unsuitable for femoral approaches.

Purpose of the Study:

  • To compare the outcomes of TAVI using the Medtronic CoreValve Revalving System (CRS) via the TAx versus the TAo approach.
  • To evaluate device success, safety, and complication rates between TAx and TAo TAVI procedures.

Main Methods:

  • A retrospective analysis of 242 consecutive TAVI procedures using Medtronic CoreValve Revalving System (CRS) across four Italian centers.
  • Patients were treated via either the TAx (61%) or TAo (39%) route.

Main Results:

  • Device success rates were comparable between TAx and TAo TAVI (P=0.16).
  • The TAo route showed a trend towards lower rates of significant paravalvular leak (6% vs. 14%, P=0.07) and significantly reduced permanent pacemaker (PPM) implantation (13% vs. 34%, P=0.017).
  • Conversely, the TAo approach was associated with a higher incidence of acute kidney injury (P=0.016) and longer hospital stays (10 days vs. 8 days, P=0.001).

Conclusions:

  • The TAo approach demonstrates comparable device success, 30-day safety, and 1-year efficacy to the TAx route for TAVI, despite a higher baseline risk profile.
  • Non-procedure-specific complications post-TAo TAVI necessitate specialized postoperative care.
  • Treatment with the TAo approach should be reserved for highly specialized and experienced centers.
Abstract

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