Alternative approaches for trans-catheter self-expanding aortic bioprosthetic valves implantation: single-center experience
Key result
Trans-catheter aortic valve implantation via surgical subclavian or direct aortic approach achieved procedural success in 11 of 12 high-risk patients with severe aortic stenosis.
Why the study?
Does trans-catheter aortic valve implantation via left axillary or direct aortic approach provide a safe and feasible alternative in patients with severe aortic stenosis and peripheral vasculopathy?
Population
12 patients with severe, symptomatic aortic stenosis and no reasonable surgical option because of excessive…
Design
Case_series
Follow-up
2 years
Authors
Discussion
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Member takes
Implication
May support alternative access in high-risk patients ineligible for transfemoral TAVI; hypothesis-generating and requires prospective confirmation.
Key Points
- To evaluate the feasibility, safety, and midterm clinical outcomes of using axillary or direct aortic access for transcatheter aortic valve implantation in patients with prohibitive iliofemoral disease.
- Conducted a single-center intervention involving 12 high-risk patients (mean age 81 ± 8 years) with severe symptomatic aortic stenosis excluded from transfemoral access due to iliofemoral arteriopathy.
- Pericardial self-expanding CoreValve bioprostheses were implanted via either the left axillary artery (n=6) or the ascending aorta through a right anterior mini-thoracotomy (n=6).
- Procedural success was achieved in 11 of 12 patients (91.7%), all of whom were discharged asymptomatic with sustained prosthetic function confirmed by echocardiography at 2 years.
- Complications included permanent pacemaker implantation in 3 patients, 1 subclavian artery dissection successfully managed with a covered stent, and 1 intraoperative conversion to femoral access resulting in death from abdominal aortic aneurysm rupture.
Study Design
Type
Observational (n=92)
Multicenter
No
Structured PICO
Does trans-catheter aortic valve implantation via left axillary or direct aortic approach provide a safe and feasible alternative in patients with severe aortic stenosis and peripheral vasculopathy?
P
Population
92 high-risk patients with severe, symptomatic aortic stenosis, including 12 with severe iliac-femoral arteriopathy who underwent TAVI via left axillary or direct aortic approaches, followed for up to 2 years.
E
Exposure
Trans-catheter aortic valve implantation (TAVI) using a self-expanding bioprosthetic valve through the left axillary artery (n=6) or directly from the ascending aorta through a right anterior mini-thoracotomy (n=6).
O
Outcome
Procedural success
Trans-catheter aortic valve implantation via surgical subclavian or direct aortic approach is a feasible and safe alternative for high-risk patients with severe aortic stenosis who are ineligible for transfemoral access.
Cite This Study
Bruschi et al. (2011) conducted an observational in Severe, symptomatic aortic stenosis (n=92). Trans-catheter aortic valve implantation via left axillary artery or direct ascending aorta was evaluated on Procedural success. Trans-catheter aortic valve implantation via surgical subclavian or direct aortic approach achieved procedural success in 11 of 12 high-risk patients with severe aortic stenosis.