"Double-Stick" Transsubclavian Transcatheter Aortic Valve Replacement With Use of a Balloon Expandable Valve: A Less...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• Transcatheter aortic valve replacement (TAVR) offers various access options, including transfemoral, transaortic, transapical, and transsubclavian routes.
• The transsubclavian approach is increasingly utilized for TAVR, particularly with balloon-expandable valves, when transfemoral access is contraindicated due to its peripheral nature.
• Current transsubclavian TAVR procedures typically require a secondary arterial access for pigtail catheter placement.

Purpose of the Study:

• To introduce and describe a "double-stick" transsubclavian technique for TAVR.
• To demonstrate that this technique eliminates the need for a second arterial access site.
• To highlight the utility of this modified approach in patients with challenging femoral vasculature.

Main Methods:

• Description of a modified transsubclavian access technique involving a "double-stick" approach.
• Application of the technique during TAVR procedures for patients unsuitable for transfemoral access.
• Assessment of the feasibility and outcomes associated with the novel technique.

Main Results:

• The described "double-stick" transsubclavian technique successfully obviates the need for a secondary arterial puncture.
• This approach facilitates the use of transsubclavian access in patients with advanced peripheral arterial disease.
• The technique allows for early patient ambulation post-procedure in the majority of cases.

Conclusions:

• The "double-stick" transsubclavian technique provides a valuable alternative access route for TAVR.
• This method expands TAVR applicability to a broader patient population, including those with severe femoral disease.
• The technique potentially improves patient recovery and mobility after TAVR.