Percutaneous trans-axilla transcatheter aortic valve replacement

Abstract

The left axillary artery is an attractive alternative access route for transcatheter aortic valve replacement (TAVR) and may provide better outcomes compared to other alternatives. Nevertheless, there remain concerns about vascular complications, lack of compressibility, and thorax-related complications. Between March 2019 and March 2021, 13 patients underwent transaxillary TAVR for severe aortic stenosis at the University Hospital Bonn. The puncture was performed with a puncture at the distal segment of the axillary artery through the axilla, with additional femoral access for applying a safety wire inside the axillary artery. Device success was defined according to the VARC 2 criteria. The study participants were advanced in age (77 ± 9 years old), and 54% were female, with an intermediate risk for surgery (STS risk score 4.7 ± 2.0%). The average diameter of the distal segment of the axillary artery was 5.8 ± 1.0 mm (i.e., the puncture site) and 7.6 ± 0.9 mm for the proximal axillary artery. Device success was achieved in all patients. 30-day major adverse cardiac and cerebrovascular events were 0%. With complete percutaneous management, stent-graft implantation was performed at the puncture site in 38.5% of patients. Minor bleeding was successfully managed with manual compression. Moreover, no thorax-related complications, hematomas, or nerve injuries were observed. Percutaneous trans-axilla TAVR was found to be feasible and safe. This modified approach may mitigate the risk of bleeding and serious complications in the thorax and be less invasive than surgical alternatives.

Low Left-Ventricular Ejection Fraction as a Predictor of Intraprocedural Cardiopulmonary Resuscitation in Patients Undergoing Transcatheter Aortic Valve Implantation

“…Transapical valve implantations have been associated with increased perioperative risks and poorer postoperative outcomes, which could contribute to the elevated rate of intraprocedural CPR [14,15]. This is also why the use of the transapical route has decreased lately and access via the axillary arteria is being used more frequently instead [16,17]. This could be especially advantageous in these high-risk patients, as it is less invasive and faces less risk of myocardial injury [18].…”

Percutaneous axillary extracorporeal membrane oxygenation supported complex left main bifurcation percutaneous coronary intervention

“…However, we describe a technique for percutaneous access for VA‐ECMO. The safety and efficacy of percutaneous axillary artery access for Impella, IABP, and transcatheter aortic valve replacement have been previously described 4–6 . Insertion of an arterial ECMO cannula has a few unique considerations.…”

“…The safety and efficacy of percutaneous axillary artery access for Impella, IABP, and transcatheter aortic valve replacement have been previously described. [4][5][6] Insertion of an arterial ECMO cannula has a few unique considerations. The size of the arterial ECMO cannula is larger…”

Advances in technology and techniques for transcatheter aortic valve replacement with concomitant peripheral arterial disease

“…In the past, surgical cut down is required to perform transaxillary and trans-subclavian TAVR. Recently, it is predominantly performed using percutaneous approaches ( 47 ). At the beginning of the procedure, an arterial puncture is performed under sonographic and fluoroscopic guidance.…”