Axillary Transcatheter Aortic Valve Replacement in Patients With Peripheral Vascular Disease

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Access Techniques

Background:

• Transcatheter aortic valve replacement (TAVR) is a standard treatment for severe aortic stenosis.
• Femoral access is the preferred route, but alternative access is needed for some patients.
• The axillary artery presents a potential alternative access site for TAVR.

Purpose of the Study:

• To evaluate the safety and efficacy of axillary artery access for TAVR.
• To report short-term clinical outcomes and complications associated with axillary TAVR.
• To assess the feasibility of axillary TAVR as an alternative to non-femoral access.

Main Methods:

• Retrospective single-center study of axillary TAVR procedures performed between 2015 and 2017.
• Inclusion of 43 patients undergoing axillary TAVR, with reporting according to VARC-2 criteria.
• Analysis of patient demographics, procedural details, valve types used (Medtronic CoreValve, Edwards Sapien3), and short-term follow-up data.

Main Results:

• Successful vascular access in all patients, with a preference for the left axillary approach (69.7%).
• Low rates of complications: 2.3% arterial vascular complication, 2.3% central neurologic morbidity, and no brachial plexus injuries.
• 30-day mortality was 6.9%, and 1-year survival was 86%. Pacemaker implantation rate was 18.6%.

Conclusions:

• Axillary TAVR is a safe and effective alternative access route for patients requiring TAVR without femoral access.
• The procedure is associated with acceptable morbidity and mortality, and satisfactory short-term clinical outcomes.
• Axillary TAVR shows promise as a primary alternative access strategy in the non-femoral TAVR population.