Right transaxillary transcatheter aortic valve replacement is comparable to left despite challenges

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• Transaxillary access is a common alternative to transfemoral access for transcatheter aortic valve replacement (TAVR).
• Left transaxillary access is typically preferred, but right transaxillary access presents anatomical challenges due to opposing arterial and aortic curvatures.
• Procedural modifications may be necessary to optimize alignment and outcomes for right transaxillary TAVR.

Purpose of the Study:

• To compare outcomes between left and right transaxillary TAVR at a single center.
• To evaluate the effectiveness of procedural modifications, specifically the "flip-n-flex" technique, in facilitating right transaxillary TAVR.

Main Methods:

• A retrospective comparison of patient characteristics and outcomes for consecutive left or right axillary TAVR procedures using SAPIEN 3 valve (June 2016 - June 2022).
• Subanalysis of the right axillary group to assess the impact of the "flip-n-flex" technique on procedural efficiency and new conduction disturbances.

Main Results:

• Twenty-five right and 26 left transaxillary TAVRs were performed. No significant differences in patient characteristics or overall outcomes were observed between the groups.
• In the right axillary group, the "flip-n-flex" technique (used in 18 patients) was associated with significantly shorter fluoroscopy times (21.2 ± 6.2 min vs. 29.6 ± 12.4 min, p=0.03).
• The "flip-n-flex" technique also showed a trend towards reduced permanent pacemaker implantation (6.3% vs. 42.9%, p=0.07) compared to cases without the technique.

Conclusions:

• Right transaxillary TAVR demonstrates comparable outcomes to left transaxillary access, despite potential anatomical difficulties.
• The "flip-n-flex" technique enhances the feasibility and efficiency of right transaxillary TAVR, making it an attractive option for patients with limited access choices.