Transcatheter Aortic Valve Replacement by a Novel Suprasternal Approach

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• Severe aortic stenosis requires intervention, with transcatheter aortic valve replacement (TAVR) being a key therapy for high-risk patients.
• Transfemoral access is standard for TAVR, but not feasible for all candidates.
• Alternative access routes are crucial for expanding TAVR accessibility.

Purpose of the Study:

• To evaluate the efficacy and outcomes of the suprasternal approach for TAVR.
• To compare the suprasternal TAVR route with other nontransfemoral approaches regarding patient mobility and hospital stay.

Main Methods:

• Eleven patients with unsuitable transfemoral access underwent TAVR via a suprasternal approach.
• Propensity matching was used to compare these patients with those who had transaortic, transapical, and trans-subclavian TAVR.

Main Results:

• Suprasternal TAVR patients ambulated earlier (median 1.6 days) compared to transaortic (median 3.9 days) (p=0.001).
• Hospitalization was shorter for suprasternal (median 4 days) and trans-subclavian (median 4 days) access compared to transaortic (median 8 days) and transapical (median 6 days) (p=0.01).
• No increase in complications was observed with the suprasternal approach.

Conclusions:

• The suprasternal TAVR approach facilitates earlier ambulation and reduced hospitalization, similar to the trans-subclavian route.
• Suprasternal access is a viable alternative for TAVR in patients with challenging transfemoral vasculature.
• Further research is needed to establish suprasternal access as the preferred alternative TAVR route.