Safety and Efficacy of the Subclavian Approach for Transcatheter Aortic Valve Implantation With the CoreValve Revalving System

Abstract

Background-Transcatheter aortic valve implantation (TAVI) is a new option for patients with severe aortic stenosis at high surgical risk. The standard retrograde approach through the femoral artery is contraindicated in case of unfavorable iliofemoral anatomy or extensive disease. In these patients, a trans-subclavian approach may be feasible. No specific complications for the subclavian access (vessel rupture, vertebral or internal mammary ischemia) were reported. The learning curve for the subclavian approach led to a wider use of local anesthesia. Thirty-day mortality was 0% versus 6.1% in the subclavian versus femoral groups, respectively (Pϭ0.13). Six-month mortality rate was 9.4% versus 15.8% (Pϭ0.44), whereas valve-related adverse events were 13.6% versus 13.9% (Pϭ0.79). Conclusions-TAVI through the subclavian approach appeared feasible and safe, with excellent procedural success and low in-hospital complication rates. This new technique allows patients with contraindications to the femoral approach to be treated with TAVI. (Circ Cardiovasc Interv. 2010;3:359-366.) Methods and Results-Between

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“…Trans-subclavian/axillary approach has the advantage that axillary artery is easily accessible after surgical cut-down and that the procedure should be performed with local anesthetic and mild sedation. However the axillary is a fragile artery and patients are not eligible for the subclavian approach in case of vessel diameter < 6 mm, heavy calcification, excessive tortuosity, or tight subclavian stenosis not amenable to percutaneous balloon angioplasty [24][25][26]. Moreover, the subclavian approach has to be considered cautiously in patients with patent left internal mammary artery graft.…”

Transcatheter Aortic Valve Implantation: State of the Art

“…Recently, the trans-subclavian approach has been developed as an alternative to the transapical approach. A technique described by Petronio et al (2010) consists of surgical exposure of the subclavian artery, followed by arterial puncture between purse-string sutures. A 6F catheter is inserted, and the 18F catheter commonly used for the transfemoral approach is placed over a guide wire.…”

Possibilities of Interventional Correction of Critical Aortic Stenosis: Contemporary State of Problem and Perspectives

“…В большинстве случаев она осуществляется доступом через бедренную артерию, как и баллон-ная вальвулопластика. Альтернативным служит до-ступ в левую подключичную артерию [30]. В случае невозможности использовать сосудистый доступ имплантация может быть проведена через верхуш-ку левого желудочка или восходящую аорту.…”