Transcaval Access and Closure for Transcatheter Aortic Valve Replacement: A Prospective Investigation.

Area of Science:

• Cardiovascular Interventions
• Minimally Invasive Surgery
• Transcatheter Valve Therapy

Background:

• Traditional transthoracic access for transcatheter aortic valve replacement (TAVR) carries significant risks.
• Transcaval access presents a percutaneous alternative, potentially reducing procedural hazards and patient discomfort.

Purpose of the Study:

• To evaluate the safety and efficacy of transcaval access for TAVR in patients ineligible for femoral access and at high risk for transthoracic procedures.
• To assess complications and outcomes associated with transcaval access and closure techniques.

Main Methods:

• A prospective, multicenter, single-arm trial involving 100 high-risk patients undergoing transcaval access for TAVR.
• Percutaneous access to the abdominal aorta was achieved using a caval guidewire and aortic snare, followed by TAVR.
• Access sites were closed with nitinol cardiac occluders; outcomes were adjudicated and assessed via CT imaging.

Main Results:

• Successful transcaval access was achieved in 99% of patients, with 98% achieving device success.
• In-hospital and 30-day survival rates were 96% and 92%, respectively.
• Life-threatening bleeding occurred in 7% and major vascular complications in 13% of patients; median hospital stay was 4 days.

Conclusions:

• Transcaval access is a viable option for TAVR in patients with limited traditional access options.
• While bleeding and vascular complications were observed, they were deemed acceptable in this high-risk population.
• Further investigation and development of dedicated closure devices are warranted to optimize this TAVR access method.