Transradial Secondary Access Transcaval Transcatheter Aortic Valve Intervention: A Single‐Center Experience

Background Transcaval transcatheter aortic valve implantation (TAVI) is well described for patients with severe peripheral arterial disease. Conventionally, secondary arterial access via the femoral artery is used to allow bail‐out stenting of the aortotomy site in case of complications. Transradial access may reduce the risk of complications related to the secondary access itself but prevents effective bail‐out. We use the transradial approach for secondary access, accepting this risk. Aim We aim to report the feasibility and acute outcomes following transcaval TAVI with transradial secondary access. Methods All patients with transcaval TAVI performed from November 2016 to March 2024 at our center were identified. Patients with secondary access via the radial artery were included. The primary outcome was postprocedural mortality to hospital discharge. Secondary outcomes were the incidence of major vascular complications, bleeding, and stroke up to 72 h after the procedure. Results A total of 20 patients were included. Procedural success was achieved in all the patients. Ten (50%) patients received cerebral protection via the right radial artery in addition to left radial secondary access. All 20 patients had successful closure of the aortotomy with a 10/8 or 8/6 mm Amplatzer ductal occluder (Abbott, USA). No patient had major complications of the aortocaval shunt either during or after the procedure. No patient needed a bailout aortic intervention. There was one death (5%) secondary to peri‐procedural stroke. Patients were usually discharged on the first postprocedural day. Conclusions Transcaval TAVI with transradial secondary access appeared to be safe. Bailout stenting is not possible but is rarely needed. Overall, procedural vascular risks are reduced.