Key result
A novel supraclavicular subclavian access approach for TAVR with the Sapien 3 valve achieved 100% procedural success and 0% mortality, stroke, or vascular injury at 30 days in five high-risk patients.
Why the study?
Does a supraclavicular subclavian approach for TAVR with a Sapien 3 valve provide safe and successful implantation in patients with unfavorable femoral access?
Case Report (n=5)
No
Does a supraclavicular subclavian approach for TAVR with a Sapien 3 valve provide safe and successful implantation in patients with unfavorable femoral access?
A novel supraclavicular subclavian approach for TAVR using the Sapien 3 valve appears feasible and safe in patients with unfavorable femoral access.
This approach should not yet alter TAVR access strategies; leaves open need for prospective validation studies.
BACKGROUND: Within the trans-subclavian approach, procedural techniques can vary widely, and reported access generally refers to an infraclavicular axillary approach. We describe and report the use of a novel supraclavicular true subclavian approach for transcatheter aortic valve replacement (TAVR) exclusively for implantation of Sapien 3 valves. CASE PRESENTATION: We report our first five consecutive patients undergoing TAVR with a Sapien 3 valve using a standardized subclavian approach at a single center. In-hospital and 30-day complications were reported. The use of this approach resulted in successful implantation in 100% of patients in a safe manner with 0% mortality, stroke, and vascular injury during hospitalization and at 30 day follow-up. The in-hospital pacemaker implantation rate was 20%. The average length of stay was 3 days. CONCLUSIONS: TAVR with Sapien implant can be safely performed with a standardized supraclavicular subclavian approach in patients with unfavorable femoral access.
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Dahle et al. (2018) conducted a case report in Severe symptomatic aortic stenosis with unfavorable femoral access (n=5). Supraclavicular subclavian access for TAVR with Sapien 3 valve was evaluated on Procedural success (implanted functioning valve) and safety (mortality, stroke, vascular injury). A novel supraclavicular subclavian access approach for TAVR with the Sapien 3 valve achieved 100% procedural success and 0% mortality, stroke, or vascular injury at 30 days in five high-risk patients.
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