Safety and efficacy of transaxillary transcatheter aortic valve replacement using a current-generation balloon-expandable valve

Abstract

Background Transaxillary access (TAx) has shown promise as an excellent alternative TAVR option, but data on the Edwards SAPIEN 3 in TAx-TAVR is limited. We sought to study the safety and efficacy of TAx-TAVR using this current-generation balloon-expandable valve. Methods A retrospective study of our first 24 TAx and 20 transthoracic (TT) TAVR patients treated with the SAPIEN 3 valve was performed, and the patients’ preoperative characteristics, procedural outcomes, and clinical outcomes were compared to our first 100 transfemoral (TF) patients using the SAPIEN 3 device. Results There were no statistical differences observed for outcomes between the TAx and TF groups, despite the TAx patients having more comorbidities (STS-PROM 11.3 ± 7.6 versus 7.3 ± 5.2, p = 0.042). In addition, no significant difference was found in the fluoroscopy time and contrast amount between the two groups. The patients’ baseline characteristics were similar between the TAx and TT groups. Their procedural and clinical outcomes were comparable, but there was a trend towards lower incidence of acute kidney injury (13.0% versus 23.5%), new-onset atrial fibrillation (5.6% versus 33.3%), shorter median length of stay postoperatively (4 versus 6 days), fewer discharges to rehabilitation (16.7% versus 35.0%), and a lower rate of readmission within 30-days (8.3% versus 35.0%), all favoring TAx access. Conclusions TAx-TAVR with the SAPIEN 3 valve is a safe alternative to TF access. It offers advantages of improved recovery over TT access, and appears to be a superior alternative-access option for TAVR. TAx access could be preferred when TF access is not feasible.

Percutaneous trans-axilla transcatheter aortic valve replacement

“…Another advantage of our technique is to be able to eliminate the risk of pneumothorax or hemothorax. Coupled with earlier knowledge [ 16 – 18 ], our findings suggest that trans-axilla TAVR serves as a safe alternative for patients who are ineligible for transfemoral arterial access.…”

The Transaxillary Route as a Second Access Option in TAVI Procedures: Experience of a Single Centre

“…With the expansion of TAVI to an increasingly large population, including low-risk patients, it is critical to establish a second choice to the TF approach. Over the years, TAX TAVI has proven to be an excellent option as a non-TF approach, although there are no RCTs [ 17 ]. Retrograde TF access is the most popular approach but may not be feasible in patients with poor femoral vascular access.…”

“…Experienced operators usually adopt the TAX technique after an adequate learning curve. This technique requires surgical exposure of the vessel and complete immobility of the patient, while the operators work in an unusual and uncomfortable position [ 17 ]. Nowadays, this technique is facilitated by new, smaller, and dedicated devices, such as the Corevalve ReValving System introducer sheath (Medtronic, CV, Luxembourg), where the outer diameter of the catheter is 15 Fr (Accu-Trak™ stability layer, Medtronic, CV, Luxembourg), and 12 Fr and the outer diameter of the valve capsule is 18 Fr.…”

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

“…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.…”