Balloon-Assisted Transaxillary Artery Closure (BATAC): A Novel Vascular Closure Approach in Patients Undergoing TAVI...

Transaxillary (TAx) access has shown comparable outcomes to transfemoral access in selected studies of transcatheter aortic valve implantation (TAVI). Although TAx-TAVI has mainly been performed via surgical cutdown under general anesthesia, a fully percutaneous approach under local anesthesia with mild sedation has recently emerged as a less invasive option. We present Balloon-Assisted Transaxillary Artery Closure (BATAC) approach and report our early clinical experience. This observational study included consecutive adult patients with severe aortic stenosis who underwent simplified TAx-TAVI. Procedures were performed via left or right axillary access under ultrasound-guidance. Two ProStyles were predeployed, and the access sheath was progressively upsized over Amplatz Super Stiff wire. During closure, the Armada balloon was inflated at 2 atm via the ipsilateral arterial access at the site of the arteriotomy. With the balloon inflated, the ProStyle suture knots were sequentially advanced one-by-one under fluoroscopic guidance all the way to the arterial wall adjacent to the inflated balloon ensuring no entrapment within the surrounding soft tissue. Twelve patients underwent TAx-TAVI using this technique. Technical success was met in all patients, and device success in 91.7%. There were no in-hospital deaths, cerebrovascular events, major vascular complications, life-threatening bleeding, or need for vascular surgery. One patient developed cardiac tamponade requiring pericardial drainage, without transfusion. One minor access-site bleeding episode was managed conservatively. A simplified percutaneous axillary artery closure strategy following TAx-TAVI was associated with excellent early procedural and clinical outcomes in this small cohort. Larger studies are warranted to validate these findings.