Alternative Transaxillary Access for Transcatheter Aortic Valve Implantation

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Transfemoral access is the standard for transcatheter aortic valve implantation (TAVI).
• Alternative access routes are crucial for patients with unsuitable iliofemoral anatomy.
• The transaxillary approach offers a potential alternative for TAVI access.

Purpose of the Study:

• To evaluate the viability and safety of a modified transaxillary approach for TAVI.
• To assess the outcomes of TAVI performed via the distal left axillary artery.
• To identify potential benefits of the transaxillary route in high-risk patients.

Main Methods:

• A single-center pilot study involving 24 high-risk patients (average age 77.9 years) with severe aortic stenosis.
• TAVI was performed using a balloon-expandable valve via the left distal axillary artery.
• Patients had iliofemoral anatomy unsuitable for transfemoral TAVI, often due to peripheral artery disease.

Main Results:

• The 30-day mortality rate was 4.2%.
• 16.7% of patients required a new pacemaker.
• One case of moderate neurological dysfunction and one access site revision for ischemia were reported.

Conclusions:

• Transaxillary TAVI via the distal left axillary artery is a practicable and safe alternative.
• This technique minimizes surgical trauma and is sparing for the brachial plexus.
• Further validation in larger, prospective studies with longer follow-up is warranted.