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Transradial Secondary Access Transcaval Transcatheter Aortic Valve Intervention: A Single-Center Experience.
Siu-Fung Wong1, James Cockburn1, Christopher Broyd1
1Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex, Brighton, UK.
Summary
Transcaval transcatheter aortic valve implantation (TAVI) using transradial secondary access is feasible and safe. This approach reduces vascular risks, though bailout stenting is not possible but rarely required.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Transcaval transcatheter aortic valve implantation (TAVI) is an alternative access route for patients with severe peripheral arterial disease.
- Conventionally, femoral artery access is used for secondary access, enabling bailout stenting.
- Transradial access offers potential benefits but limits bailout options.
Purpose of the Study:
- To evaluate the feasibility and acute outcomes of transcaval TAVI utilizing transradial secondary access.
- To assess the safety and efficacy of this modified TAVI approach.
Main Methods:
- Retrospective review of patients undergoing transcaval TAVI with transradial secondary access from November 2016 to March 2024.
- Primary outcome: postprocedural mortality to hospital discharge.
- Secondary outcomes: major vascular complications, bleeding, and stroke within 72 hours.
Main Results:
- Procedural success in all 20 included patients.
- Successful aortotomy closure in all patients using an Amplatzer ductal occluder.
- No major aortocaval shunt complications or need for bailout aortic intervention.
- One death (5%) due to peri-procedural stroke; most patients discharged on postprocedural day 1.
Conclusions:
- Transcaval TAVI with transradial secondary access is a safe alternative.
- The need for bailout stenting is minimal, making this approach viable.
- This strategy appears to reduce overall procedural vascular risks.
