Transcaval Transcatheter Aortic Valve Replacement: Clinical Outcomes From a TAVI Program Without Prior Transcaval...

Despite the emergence of the transcaval (TCv) access route for transcatheter aortic valve implantation (TAVI) in the treatment of patients with hostile iliofemoral anatomy, the number of patients reported in clinical series of TCv TAVI has been relatively small (< 500 published cases). We assessed procedural and clinical outcomes in a prospective cohort of patients undergoing TAVI using TCv access at a clinical site without prior TCv TAVI experience.

A prospective TAVI database was used to identify all patients treated with TCv TAVI at our center. Baseline clinical and procedural data, and clinical outcomes at follow-up were assessed. The Valve Academic Research Consortium (VARC) consensus document for standardized endpoints was used.

Between February 2020 and July 2024, a total of 21 patients underwent TCv TAVI. The mean age of the cohort age was 76 ± 6 years, most were female (N = 13, 62%), and the mean STS score was 7.4 ± 5.8%. We achieved a technical and clinical success rate of 100% and 95%, respectively. The mean duration of in-hospital stay was 3.4 ± 1.5 days. There was one central aortic complication in a patient who required balloon tamponade to treat bleeding into the retroperitoneum from the aorto-caval tract and one peripheral vascular complication in a patient who required a direct thrombin injection to treat a femoral artery pseudoaneurysm. The rate of permanent pacemaker implantation was 20% (N = 4) and the incidence of stroke and/or death at 30 days was 0%. The mean follow-up time of the cohort was 2.5 ± 1.4 years with a 1-year Kaplan-Meier survival estimate of 89.6% (95% confidence interval of 64.3%-97.3%).

When performed by an experienced TAVI operator with peripheral vascular and structural training, with limited up-front proctoring for procedures and input from imaging specialists, this series supports that TCv TAVI can achieve a high rate of procedural success with low risk of mortality and stroke.