Supraclavicular Subclavian access for Sapien Transcatheter aortic valve replacement- a novel approach

Abstract

BackgroundWithin the trans-subclavian approach, procedural techniques can vary widely, and reported access generally refers to an infraclavicular axillary approach. We describe and report the use of a novel supraclavicular true subclavian approach for transcatheter aortic valve replacement (TAVR) exclusively for implantation of Sapien 3 valves.Case presentationWe report our first five consecutive patients undergoing TAVR with a Sapien 3 valve using a standardized subclavian approach at a single center. In-hospital and 30-day complications were reported. The use of this approach resulted in successful implantation in 100% of patients in a safe manner with 0% mortality, stroke, and vascular injury during hospitalization and at 30 day follow-up. The in-hospital pacemaker implantation rate was 20%. The average length of stay was 3 days.ConclusionsTAVR with Sapien implant can be safely performed with a standardized supraclavicular subclavian approach in patients with unfavorable femoral access.

Alternate Access for TAVI: Stay Clear of the Chest

“…47 Most data on TS access feasibility has been reported with the Medtronic CoreValve and first-generation Edwards SAPIEN THVs, although some recent reports hinted at favourable outcomes with newer generation SAPIEN 3 and Evolut™ R valving systems. 57,58 Recent registry data suggest that the use of the TS approach is declining. Indeed, the alternative TS access was performed Another more recent observational report of 202 patients compared TA and TS approaches and found no significant association of access site with mortality in the multivariable analysis.…”

Delivery balloon rupture during transcatheter heart valve alignment procedure in extreme descending aorta tortuosity

“…A transascending aortic approach would be safer in patients with low ejection fraction than a transapical approach, because any myocardial damage can be avoided with its use. A previous case study reported an S3 valve had been deployed with the transsubclavian approach [5], but our patient's subclavian artery was too narrow for the device to pass through. For these reasons, the decision was made to perform S3 TAVR via the femoral artery.…”

Facilitating right‐sided axillary artery access for transcatheter aortic valve replacement using the Edwards Sapien 3 and ultra valves: Technical considerations

“…Other authors have suggested that the Safari wire fails to provide sufficient support for the axillary approach, but this has not been our experience, after using it in all but one case. In addition, the Safari provided a more stable platform for pacing 9 …”

“…The most commonly used device for TAx‐TAVR is the Medtronic self‐expandable CoreValve system 4 . However, use of the Edwards LifeSciences’ balloon expandable Sapien 3 prosthesis (Edwards Inc., Irvine, CA) has also been described in off‐label use in an American series 7–9 . In this article, we describe the procedural modifications required in order to permit right‐sided TAx‐TAVR using the Edwards S3 and Ultra valve systems.…”

“…earthslab.com/anatomy/axillary-artery one case. In addition, the Safari provided a more stable platform for pacing 9. With the Safari wire in place, the 6 French arterial sheath was removed followed by dilatation of the arterial access site and placement of the 14 French Edwards eSheath (Edwards Lifesciences Inc., Irvine, CA) when using the Edwards S3 and 14 French Axela sheath with the Edwards Ultra Valve.…”