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Background:Although not yet recommended by the guidelines, distal radial access, a new site for cardiovascular interventions, has been rapidly acknowledged and adopted by many centers due to its high rate of success, safety and fewer complications. We present our experience using secondary distal radial access during transcatheter aortic valve implantation (TAVI), proposing a new, even more minimal approach. Methods: As of November 2020, a systematic distal radial approach as secondary access site for TAVI was adopted in our center. Primary endpoints were technical success and major adverse events (MAEs). Secondary endpoints: the access site complication rate, hemodynamic and clinical results of the intervention, procedural related factors, crossover rate to the femoral access site, and hospitalization duration (in days). Results: From November 2020, 41 patients underwent TAVI using this strategy. Patients had a mean age of 76 ± 11.2 years, 41% were male. Six (14.63%) patients received a balloon-expandable valve and 35 (85.37%) received a self-expandable valve. TAVI was successful in all cases. No complications occurred due to transradial access. Puncture success, defined as completed sheath placement was maximum (N = 41/41,100%) and emergent transfemoral secondary access was not required in any case. Primary transfemoral vascular access site complications occurred in 7 cases (17%) of which 4 (13.63%) were resolved through distal radial access: one occlusion, two flow-limiting stenoses and four perforations of the common femoral artery. There were no additional major vascular complications at 30 days. Overall MACE rate was 2.4%. Conclusion:The use of the distal radial approach for secondary access in TAVI is safe, feasible and has several advantages over old access sites.

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In this article, we present the case of an 81-year-old male patient having left ventricular systolic dysfunction partly due to chronic myocardial ischaemia who was diagnosed with true severe aortic valve stenosis. After treatment of coronary artery stenosis, transcatheter aortic valve implantation (TAVI) was indicated, but the course of the disease was rapidly progressive, left ventricular systolic dysfunction became very severe by the time of the planned intervention, and acute right ventricular failure developed as a consequence as well. No haemodynamic instability occurred therefore the intervention could be postponed and could be performed routinely without any significant risks after successful inotropic therapy. Based on the one-year follow-up, TAVI was successful, left and right ventricular systolic function almost completely normalized.

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