Percutaneous trans-axilla transcatheter aortic valve replacement

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Surgical Innovation

Background:

• The left axillary artery offers a promising alternative access route for transcatheter aortic valve replacement (TAVR).
• Concerns regarding vascular and thorax-related complications persist with axillary artery access.
• Optimizing TAVR access routes is crucial for improving patient outcomes and procedural safety.

Purpose of the Study:

• To evaluate the feasibility and safety of percutaneous trans-axillary TAVR.
• To assess vascular and thorax-related complications associated with the trans-axillary approach.
• To determine device success rates and 30-day major adverse cardiac and cerebrovascular events in trans-axillary TAVR.

Main Methods:

• A prospective study involving 13 patients with severe aortic stenosis undergoing trans-axillary TAVR.
• Puncture of the distal axillary artery with additional femoral access for safety wire placement.
• Evaluation of device success per VARC 2 criteria and monitoring of adverse events.

Main Results:

• Successful device implantation in all 13 patients (100% device success).
• Zero major adverse cardiac and cerebrovascular events within 30 days.
• No thorax-related complications, hematomas, or nerve injuries observed; minor bleeding managed conservatively.

Conclusions:

• Percutaneous trans-axillary TAVR is a feasible and safe procedure.
• This approach may reduce the risk of thoracic complications and bleeding compared to surgical alternatives.
• Trans-axillary TAVR demonstrates excellent early outcomes and warrants further investigation.