PERCUTANEOUS TRANSAXILLARY TRANSCATHETER AORTIC VALVE IMPLANTATION.

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis.
• The transfemoral (TF) approach is most common, but challenging in patients with poor iliofemoral access.
• The transaxillary (TAX) approach offers an alternative, but percutaneous closure remains a critical consideration.

Observation:

• This paper details the successful percutaneous implantation of a CoreValve Evolut Pro transcatheter heart valve via the left axillary artery.
• The patient presented with severe aortic stenosis and small, calcified femoral arteries, precluding TF access.
• The procedure was performed successfully, demonstrating feasibility in a challenging anatomical scenario.

Findings:

• Percutaneous transaxillary TAVI using the CoreValve Evolut Pro is technically feasible.
• The procedure yielded comparable short and long-term clinical outcomes to other TAVI approaches.
• Successful axillary artery closure was achieved, addressing a key limitation of the percutaneous TAX approach.

Implications:

• Percutaneous transaxillary TAVI is a safe and effective alternative for patients unsuitable for TF access.
• This approach expands TAVI eligibility to a broader patient population with complex vascular anatomy.
• Further research into optimal closure techniques for percutaneous TAX TAVI is warranted.