Key result
Suprasternal TAVR in patients with complex vascular access was feasible and safe, resulting in 0% 30-day mortality, a 6.9% stroke rate, and a 6.9% pacemaker rate.
Why the study?
Suprasternal access has emerged as a viable alternate approach for TAVR in patients with very complex vascular access, but early outcome data remain limited.
Does suprasternal transcatheter aortic valve replacement provide safe early outcomes in patients with severe aortic stenosis and difficult femoral access?
Cohort (n=29)
No
Does suprasternal transcatheter aortic valve replacement provide safe early outcomes in patients with severe aortic stenosis and difficult femoral access?
Suprasternal TAVR appears to be a feasible and safe alternative access route with acceptable 30-day outcomes for patients with severe aortic stenosis who are unsuitable for transfemoral access.
May support suprasternal access in select complex cases; leaves open need for randomized comparisons to other routes.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is now an established treatment option for patients with severe aortic stenosis. The most utilized approach remains transfemoral. In patients with difficult femoral access a variety of alternate approaches have been used. Recently, suprasternal access has emerged as a viable alternate approach in patients with very complex vascular access. We describe our 30-day outcomes of patients who underwent suprasternal transcatheter aortic valve replacement (suprasternal [SS]-TAVR), which constitutes the largest single-center cohort to date. METHODS: From May 2016 to September 2021, 658 patients underwent TAVR at our institution. Of which 29 underwent SS-TAVR. We performed a retrospective analysis to evaluate early (30 days) outcomes of this procedure. Main outcomes evaluated included 30-day mortality, stroke and pacemaker rates, length of stay, readmission, and valvular function. RESULTS: All patients were alive 30 days after the procedure. The median hospital length-of-stay was 2 days. Two patients (6.9%) had a stroke on the contra-lateral side of access. Two patients (6.90%) had significant cardiac arrhythmias requiring pacemaker placement. In 30 days, one patient was readmitted (3.45%). CONCLUSIONS: Our data confirm the SS-TAVR as a feasible and safe alternative with comparable results to established approaches in patients who are unsuitable for femoral artery access and offers clinicians another access site in patients with very complex anatomy.
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Oliveira et al. (2022) conducted a cohort in Severe aortic stenosis with difficult femoral access (n=29). Suprasternal transcatheter aortic valve replacement (SS-TAVR) was evaluated on 30-day mortality. Suprasternal TAVR in patients with complex vascular access was feasible and safe, resulting in 0% 30-day mortality, a 6.9% stroke rate, and a 6.9% pacemaker rate.
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