Right Axillary Artery Access for Aortic Valvuloplasty in Infants Under One Year: A Focus on Procedural Technique

Axillary artery (AA) access for balloon aortic valvuloplasty (BAV) is an attractive approach, as it provides a trajectory similar to that of the carotid artery. However, its use in young infants remains largely unexplored. The medical records of young infants who underwent attempted AA or femoral artery (FA) access for BAV at Stead Family Children's Hospital between January 1, 2022, and July 1, 2023 were reviewed. Five patients underwent the procedure through the AA, and 6 patients through the FA. The median age and weight were 60 days (11-120) and 6 kg (4-8), respectively. The AA group had significantly lower fluoroscopy time and radiation dose with a median of 12 min (6-13) in the AA group versus a median of 20 min (16.3-29) in the FA group, and a median of 15 µGy.m² (8-18) in the AA group versus 35.6 µGy.m² (26.4-45.1) in the FA group. Also, the procedure time was lower in the AA group compared with the FA group: 61 min (50-90) versus 98 min (64.8-147); however, this difference was statistically insignificant (P = 0.1), likely due to the small sample size. No access site-related complications were encountered in either group, either immediately after the procedure or during follow-up. These findings suggest that AA access for BAV in young infants is probably both feasible and safe, and is associated with reduced radiation exposure as well as a tendency toward shorter procedure times. However, larger studies are needed to validate these results from this small study.