Safety and efficacy of the percutaneous transaxillary access for transcatheter aortic valve implantation using various transcatheter heart valves in 100 consecutive patients

U Schäfer; F Deuschl; N Schofer; C Frerker; T Schmidt; K H Kuck; F Kreidel; J Schirmer; I Mizote; H Reichenspurner; S Blankenberg; H Treede; L Conradi

doi:10.1016/j.ijcard.2017.01.010

Safety and efficacy of the percutaneous transaxillary access for transcatheter aortic valve implantation using various transcatheter heart valves in 100 consecutive patients

Int J Cardiol. 2017 Apr 1:232:247-254. doi: 10.1016/j.ijcard.2017.01.010. Epub 2017 Jan 7.

Authors

U Schäfer¹, F Deuschl², N Schofer², C Frerker³, T Schmidt³, K H Kuck³, F Kreidel³, J Schirmer⁴, I Mizote², H Reichenspurner⁴, S Blankenberg², H Treede⁴, L Conradi⁴

Affiliations

¹ Department for General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Germany. Electronic address: u.schaefer@uke.de.
² Department for General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
³ Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany.
⁴ Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.

PMID: 28118931
DOI: 10.1016/j.ijcard.2017.01.010

Abstract

Objectives: Transcatheter Aortic Valve Implantation (TAVI) can be performed via the transaxillary approach, but data about complications and procedural outcome is limited.

Introduction: TAVI is an established treatment option for patients at high risk for conventional aortic valve replacement. Nowadays, the transfemoral approach is the most commonly used access for TAVI. Nevertheless, the transfemoral access is not suitable in many patients necessitating alternative approaches.

Methods: We analyzed the outcome of 100 consecutive cases receiving percutaneous transaxillary TAVI at two different hospitals. Data were retrospectively analyzed by means of procedural, hemodynamic and clinical outcome. In addition, 1st versus 2nd generation devices were analyzed.

Results: Mean age was 78.2±2.1years and the logEuroSCORE I was 24.6±13.9%. Transaxillary TAVI was performed in 85% via the left and in 15% via the right axillary artery. Device success was achieved in 95%. In general, there was a clear learning curve with this approach. No patient experienced a major and 11% a minor access site complication. There was one procedural death (annular rupture) and one peri-procedural TIA. 23% of the patients received a new pacemaker. At discharge, effective orifice area was 1.94±0.16cm² and the mean aortic gradient was 6.8±2.1mmHg. Moderate aortic regurgitation/paravalvular leakage was documented in two patients. Mortality rates at 30days and one year were 6% and 14.8%. Last but not least, 2nd generation devices showed improved procedural outcomes.

Conclusions: The percutaneous transaxillary access for TAVI is technically feasible and safe thereby yielding excellent clinical results.

Condensed abstract: We investigated In 100 consecutive patients undergoing percutaneous transaxillary transcatheter aortic valve implantation thereby demonstrating that this approach is technically feasible and safe with acceptable numbers of minor vascular complications.

Keywords: Aortic stenosis; Transaxillary access; Transcatheter aortic valve implantation.

Publication types

Multicenter Study

MeSH terms

Aged
Aortic Valve Stenosis / diagnosis
Aortic Valve Stenosis / surgery*
Axillary Artery
Cardiac Catheterization / methods*
Echocardiography, Transesophageal
Female
Follow-Up Studies
Germany / epidemiology
Heart Valve Prosthesis*
Humans
Incidence
Male
Multidetector Computed Tomography
Postoperative Complications / epidemiology
Prosthesis Design
Retrospective Studies
Risk Assessment*
Risk Factors
Survival Rate / trends
Transcatheter Aortic Valve Replacement / methods*
Treatment Outcome