Percutaneous Transaxillary versus Surgically-Assisted Transsubclavian TAVR: A Single Center Experience

Wilkins, Ben; Bielauskas, Gintautas; Costa, Giulia; Fukutomi, Motoki; Søndergaard, Lars

doi:10.1080/24748706.2020.1849882

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…In a propensity-matched analysis of percutaneous versus surgical transaxillary access in TAVR, major vascular complications occurred in 3.0% versus 1.5% of the respective groups; however, the exact definition for these complications is not provided in the report 4 . In another study where the average hospital stay was 1.2 days, with 83% of cases being discharged the following day, no bleeding or vascular complications were documented 6 . In our analysis, the median time for the highest hemoglobin decline was 2 days (IQR: 1–2.5 days) after the intervention.…”

Section: Discussionmentioning

confidence: 93%

Percutaneous transaxillary approach through the first segment of the axillary artery for the Impella-supported PCI Versus TAVR

Sacha,

Krawczyk,

Gwóźdź

et al. 2024

Sci Rep

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Percutaneous transaxillary approach (PTAX) through the first segment of the axillary artery is not widely recognized as a safe method. Furthermore, PTAX has never been directly compared between Impella-supported percutaneous coronary interventions (Impella-PCI) and transcatheter aortic valve replacement (TAVR). This study evaluated the feasibility and safety of PTAX through the first axillary segment in Impella-PCI versus TAVR. In cases where standard imaging guidance was insufficient, a technique involving puncturing the axillary artery “on-the-balloon” was employed. The endpoints were bleeding and vascular complications, as defined by BARC and VARC-3 criteria. PTAX was successfully performed in all 46 attempted cases: 23 for Impella-PCI and 23 for TAVR. Strict adherence to BARC and VARC-3 criteria led to the frequent identification of major bleeding (57%) and a moderately frequent diagnosis of vascular complications (17%). These incidences were primarily based on post-procedural hemoglobin reduction (> 3 g/dl) but not overt bleeding. The Impella group exhibited a higher rate of BARC 3b bleeding due to a greater hemoglobin decline resulting from the prolonged implant duration and PCI itself. Left axillary access was linked to smaller blood loss. Bleeding and vascular complications, as per BARC and VARC-3 definitions, did not affect short-term prognosis, with only 3 Impella patients succumbing to heart failure unrelated to the procedures during one-month follow-up period.

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Section: Discussionmentioning

confidence: 93%

Percutaneous transaxillary approach through the first segment of the axillary artery for the Impella-supported PCI Versus TAVR

Sacha,

Krawczyk,

Gwóźdź

et al. 2024

Sci Rep

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“…Although transapical access was the most used alternative access in the early days of TAVR, there is now a worldwide tendency to avoid transthoracic access and use percutaneous transvascular alternative access instead. Over the past few years, transaxillary, transsubclavian and transcarotid access have become the more popular alternative access routes for TAVR (30)(31)(32). Transapical TAVR may also still be needed, thereby requiring "reverse" loading of the THV within its delivery system.…”

Section: Accessmentioning

confidence: 99%

Patient-Tailored Aortic Valve Replacement

Wong

Wilkins

Carranza

et al. 2021

Front. Cardiovasc. Med.

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Contemporary surgical and transcatheter aortic valve interventions offer effective therapy for a broad range of patients with severe symptomatic aortic valve disease. Both approaches have seen significant advances in recent years. Guidelines have previously emphasized ‘surgical risk’ in the decision between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), although this delineation becomes increasingly obsolete with more evidence on the effectiveness of TAVR in low surgical risk candidates. More importantly, decisions in tailoring aortic valve interventions should be patient-centered, accounting not only for operative risk, but also anatomy, lifetime management and specific co-morbidities. Aspects to be considered in a patient-tailored aortic valve intervention are discussed in this article.

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“…Due to unfavorable outcomes associated with transapical and transaortic access, [10] , [11] other alternative access routes have been developed including transsubclavian (TSc) and transaxillary (TAx). [12] , [13] , [14] While preferences for alternative access TAVR approaches vary and depend on operator preference, institutional experience and patient anatomy, alternative access site choice is critical.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Transfemoral versus Transsubclavian/Transaxillary access for transcatheter aortic valve replacement: A systematic review and meta-analysis

Abusnina¹,

Balakrishna²,

Ismayl³

et al. 2022

IJC Heart & Vasculature

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Percutaneous Transaxillary versus Surgically-Assisted Transsubclavian TAVR: A Single Center Experience

Cited by 6 publications

References 11 publications

Percutaneous transaxillary approach through the first segment of the axillary artery for the Impella-supported PCI Versus TAVR

Percutaneous transaxillary approach through the first segment of the axillary artery for the Impella-supported PCI Versus TAVR

Patient-Tailored Aortic Valve Replacement

Comparison of Transfemoral versus Transsubclavian/Transaxillary access for transcatheter aortic valve replacement: A systematic review and meta-analysis

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