Direct Percutaneous Access Technique for Transaxillary Transcatheter Aortic Valve Implantation

Schäfer, Ulrich; Ho, Yiu‐Wing; Frerker, Christian; Schewel, Dimitry; Sánchez‐Quintana, Damian; Schöfer, Joachim; Bijuklic, Klaudija; Meincke, Felix; Tourdias, Thomas; Kreidel, Felix; Kück, Karl‐Heinz

doi:10.1016/j.jcin.2011.11.014

Cited by 121 publications

(85 citation statements)

References 26 publications

(22 reference statements)

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“…[9][10][11] In our patient, vessel dimension and tortuosity made this option suboptimal. In addition to having small-caliber vessels, our patient was undergoing hemodialysis through a left brachial fistula, and even a limited dissection might have simultaneously jeopardized the LIMA and the fistula.…”

Section: Discussionmentioning

confidence: 77%

Transcatheter Aortic Valve Implantation Despite Challenging Vascular Access

Nascimbene¹,

Azpurua²,

Livesay³

et al. 2015

Texas Heart Institute Journal

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T ranscatheter aortic valve implantation (TAVI) has emerged as a mainstream therapeutic option for valve replacement in patients who are at extreme surgical risk.1 Cardiologists and cardiac surgeons now consider TAVI in patients who have been deemed poor candidates for aortic valve replacement because of their substantial comorbidities.2-4 Careful preoperative planning is crucial in selecting the proper strategy, avoiding intraoperative pitfalls in patients with marginal overall reserve, and minimizing surgical intervention for aortic valve stenosis. 5 The TAVI procedure requires expertise in peripheral and coronary interventional techniques, including large-bore intravenous access. 6 Until recently, lower-profile delivery systems for TAVI were not available in the United States.We describe a case of TAVI that was complicated by severe peripheral artery disease. The elderly patient had contraindications to vascular access that initially made him ineligible for TAVI, so we also describe the additional interventions that were necessary to enable TAVI. Case ReportIn May 2012, a 78-year-old man with critical limb ischemia, recurrent angina, prior aortocoronary bypass, severe aortic stenosis, and New York Heart Association functional class IV symptoms of heart failure was referred for possible aortic valve replacement. His estimated Society of Thoracic Surgeons risk score for TAVI was 21%.2 His aortic valve area was 0.6 cm 2 /cm 2 , which resulted in secondary pulmonary hypertension, a systolic pulmonary artery pressure of approximately 70 mmHg, a moderately depressed left ventricular ejection fraction (0.45), and chronic atrial fibrillation. The patient had substantial additional comorbidities, including end-stage renal disease and tissues weakened by previous mediastinal radiation therapy for a lymphoma.Transesophageal echocardiograms revealed a 20-mm annular diameter. This annular size necessitated the use of a 23-mm Edwards Sapien ® valve (Edwards Lifesciences LLC; Irvine, Calif ), delivered through a 22F RetroFlex ® delivery system (Edwards Lifesciences) in accordance with the manufacturer's recommendation. A 7-mm vessel

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Section: Discussionmentioning

confidence: 77%

Transcatheter Aortic Valve Implantation Despite Challenging Vascular Access

Nascimbene¹,

Azpurua²,

Livesay³

et al. 2015

Texas Heart Institute Journal

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“…21 However, validation of this approach also depends on the confirmation of its safety, since severe bleeding complications may result from the failure of the device to perform haemostasis.…”

Section: Discussionmentioning

confidence: 99%

Acesso pela artéria subclávia para implante por cateter da bioprótese valvar aórtica CoreValve®: dados do registro brasileiro

Júnior¹,

Carvalho²,

Siqueira³

et al. 2012

Rev. Bras. Cardiol. Invasiva

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Background: Transfemoral access is the preferred approach for transcatheter aortic valve implantation. However, some conditions, such as the presence of peripheral vascular disease, preclude the use of such access. In these cases, subclavian access is an alternative approach for this procedure. This study aimed at evaluating the Brazilian experience using the subclavian approach for transcatheter CoreValve ® prosthesis implantation. Methods: An aortic valve area < 1 cm 2 ; an aortic valve ring ≥ 20 mm and ≤ 27 mm (26 mm and 29 mm CoreValve  ); an ascending aorta ≤ 43 mm; and a subclavian artery with a diameter ≥ 6 mm, with no significant obstructive lesions, marked tortuosity, and excess calcification were requisites for the procedure. Access through the subclavian artery was obtained by surgical dissection and, under direct vision, a subclavian artery puncture was performed. Once artery access was obtained, the standard technique was used.

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“…Patients treated with more than one prostheses and patients with vascular complications were excluded from this analysis. Exclude were seven patients who underwent TAVI via the transaxillary approach [8]; two patients that underwent TAVI for a failed bioprosthetic aortic valve ("valve-in-valve" procedure) [9]; six patients with valve migration into the ascending aorta necessitating implantation of a second prosthesis [10]; 31 patients with femoral artery vascular access site complications requiring in either angioplasty or surgical intervention [11]; and six patients with intra-procedural cardiogenic shock or cardiac tamponade. Thus, the final study cohort included 248 patients treated with uncomplicated transfemoral TAVI.…”

Section: Materials and Methods Study Populationmentioning

confidence: 99%

Radiation dose of patients undergoing transcatheter aortic valve implantation: A comparison between edwards SAPIEN XT and medtronic corevalve aortic valve prostheses

Steinvil

Aviram

Konigstein

et al. 2013

Cathet Cardio Intervent

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Direct Percutaneous Access Technique for Transaxillary Transcatheter Aortic Valve Implantation

Abstract: Direct puncture of the axillary artery for TAVI is feasible and safe if a wire is placed into the subclavian artery via the ipsilateral brachial artery.

Cited by 121 publications

References 26 publications

Transcatheter Aortic Valve Implantation Despite Challenging Vascular Access

Transcatheter Aortic Valve Implantation Despite Challenging Vascular Access

Acesso pela artéria subclávia para implante por cateter da bioprótese valvar aórtica CoreValve®: dados do registro brasileiro

Radiation dose of patients undergoing transcatheter aortic valve implantation: A comparison between edwards SAPIEN XT and medtronic corevalve aortic valve prostheses

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