Feasibility and safety of transcaval transcatheter aortic valve implantation: a multicentre European registry

Abstract

Aims: A transfemoral transarterial approach is considered the preferable access route for transcatheter aortic valve implantation (TAVI), followed by a transaxillary/subclavian TAVI approach. However, these approaches may not be an option in all patients. This study aimed to report the initial European experience with transfemoral transcaval TAVI.Methods and results: Data on 50 patients treated by transcaval TAVI in five European centres were collected and analysed according to the Valve Academic Research Consortium (VARC)-2 definitions. The study population had a mean age of 78.7±8.0 years and a high surgical risk profile (median STS risk score 6.1%, interquartile range 3.0-11.2%). Transcaval access was successful in 49 out of 50 patients and device success was obtained in 94% of cases. Closure of the caval-aortic puncture site with a nitinol cardiac occluder was successful in all cases without need for emergent surgery. One patient received additional sealing of the aortic puncture site with a covered stent one day post TAVI due to a gradual haemoglobin drop of 3 g/dL. VARC-2-defined life-threatening bleeding and major vascular complications possibly related to transcaval access were 4% and 10%, respectively. There were no bleeding or vascular complications after discharge. At 30 days, the clinical efficacy endpoint was reached in 88% of patients.Conclusions: Transfemoral transcaval access proved to be a feasible and safe TAVI approach for highrisk patients with severe aortic stenosis not suitable for transfemoral or transaxillary/subclavian transarterial access.

Transcatheter Electrosurgery: A Narrative Review

“…At 12 months, there were no postdischarge vascular complications despite universal implantation of permeable vascular nitinol occluders. 11 Results were similar in an early European 12 and Israeli 13 reports.…”

Transcaval transcatheter aortic valve implantation in bicuspid aortic valve: A step‐by‐step procedural guidance

“…In this case report, we describe the step-by-step procedural guidance. Based on our previous experiences, 3,6 we concluded that a good anatomical selection, precise cava-aorta puncture, and complete shunt occlusion contribute to the success of the transcaval procedure.…”

“…Previous studies have shown the feasibility and safety of transcaval TAVI. [3][4][5] Additionally, transcaval TAVI requires a similar setting in the operation room as transfemoral TAVI with good radiation protection and without the change of operators' positions. In this case report, we describe the step-by-step procedural guidance.…”

Do we need alternative access in TAVR anymore?

“…The third nFP access for TAVR not addressed in these two papers is the transcarotid (TC) access. Surprisingly, the authors of the first paper 9 proposed the transcaval approach to their patients not suitable for either the transfemoral or axillary approach and did not first consider the TC approach. The TC-TAVR approach (Figure 1) represented 3.4% of patients treated with TAVR in the FRANCE TAVI registry 2 .…”

“…In this issue of EuroIntervention, two papers 9,10 report the results of two alternative nFP access routes for TAVR procedures. The first paper by Costa et al 9 reports the initial European experience of transcaval TAVR.…”