Key result
Left subclavian TAVI proves feasible and safe in a patient with a patent LIMA-LAD graft.
Why the study?
The feasibility and safety of transcatheter aortic valve implantation via left subclavian access in patients with a patent LIMA to LAD graft and abdominal aortic thrombi is unclear.
Is transcatheter aortic valve implantation via the left subclavian artery feasible and safe in a patient with a patent LIMA to LAD graft?
Case Report (n=1)
Is transcatheter aortic valve implantation via the left subclavian artery feasible and safe in a patient with a patent LIMA to LAD graft?
The presence of a LIMA to LAD graft is not an absolute contraindication for homolateral subclavian access during TAVI.
Subclavian access may be feasible in TAVR with abdominal aortic thrombi; leaves open need for prospective safety data.
We present a case of successful implantation of the Corevalve aortic bioprosthesis via the left subclavian artery in a patient with a patent internal mammary graft to the left anterior descending artery. This unusual choice of access, in the presence of adequate caliber femoral arteries, was justified by the presence of mobile thrombi in the abdominal aorta. The risk of thrombus dislodgement and subsequent major cholesterol embolization was deemed higher than the risk of coronary ischemia due to the large caliber sheath required for transcatheter aortic valve implantation. This case shows that presence of a LIMA to LAD graft is not an absolute contraindication for homolateral subclavian access and that the procedure is feasible and relatively safe provided that certain rules are followed.
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Marco et al. (2009) conducted a case report in Aortic valve disease requiring TAVI with a patent LIMA to LAD graft and abdominal aortic thrombi (n=1). Transcatheter aortic valve implantation via left subclavian access was evaluated on Procedural success and safety. Transcatheter aortic valve implantation via the left subclavian artery was feasible and relatively safe in a patient with a patent LIMA to LAD graft.
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