Trans‐subclavian versus transapical access for transcatheter aortic valve implantation: A multicenter study

Ciuca, Cristina; Tarantini, Giuseppe; Latib, Azeem; Gasparetto, Valeria; Savini, Carlo; Eusanio, Marco Di; Napodano, Massimo; Maisano, Francesco; Gerosa, Gino; Sticchi, Alessandro; Marzocchi, Antonío; Alfieri, Ottavio; Colombo, Antonio; Saia, Francesco

doi:10.1002/ccd.26012

Cited by 52 publications

(47 citation statements)

References 20 publications

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“…Despite a paucity of randomized data on alternate extra-thoracic access such as trans-carotid, subclavian or trans-axillary, single center experience suggests these approaches compare favorably to transthoracic, with acceptable rates of bleeding and vascular access complications (17,22,23). None of these had systematic follow-up imaging or independent adjudication.…”

Section: Discussionmentioning

confidence: 99%

Transcaval Access and Closure for Transcatheter Aortic Valve Replacement

Greenbaum

Babaliaros

Chen

et al. 2017

Journal of the American College of Cardiology

189

124

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Background Transcaval access may enable fully percutaneous transcatheter aortic valve replacement (TAVR) without the hazards and discomfort of transthoracic (transapical or transaortic) access. Objectives We performed a prospective, independently-adjudicated, multi-center, single-arm Investigational Device Exemption trial of transcaval access for TAVR in patients ineligible for femoral artery access and high or prohibitive risk of complications from transthoracic access. Methods 100 subjects underwent attempted percutaneous transcaval access to the abdominal aorta by electrifying a caval guidewire and advancing into a prepositioned aortic snare. After exchanging for a rigid guidewire, conventional TAVR was performed through transcaval introducer sheaths. Transcaval access ports were closed with nitinol cardiac occluders. A core lab analyzed pre-discharge and 30-day abdominal CT. The STS predicted risk of mortality was 9.6 ± 6.3%. Results Transcaval access was successful in 99/100 subjects. Device success (access and closure with a nitinol cardiac occluder without death or emergency surgical rescue) was 98/99, except for one closed only with a covered stent. Inpatient survival was 96% and 30-day survival was 92%. VARC2 life-threatening bleeding and modified VARC2 major vascular complications possibly related to transcaval access were 7% and 13%, respectively. Median length of stay was 4 (2–6) days. There were no vascular complications after discharge. Conclusion Transcaval access enabled TAVR in patients who were not good candidates for transthoracic access. Bleeding and vascular complications, using permeable nitinol cardiac occluders to close the access ports, were common but acceptable in this high risk cohort. Transcaval access should be investigated in patients who are eligible for transthoracic access. Purpose-built closure devices are in development that may simplify the procedure and reduce bleeding. Clinical trial NCT02280824 on clinicaltrials.gov

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Section: Discussionmentioning

confidence: 99%

Transcaval Access and Closure for Transcatheter Aortic Valve Replacement

Greenbaum

Babaliaros

Chen

et al. 2017

Journal of the American College of Cardiology

189

124

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“…5 The TC access has the potential to alleviate some of drawbacks of the other non-femoral approaches, given its minimally-invasive nature. 35,[46][47][48] Previous reports demonstrated the feasibility and safety of the TC approach, mostly with the Medtronic CoreValve THV. 43,49,50 Our experience with the SAPIEN devices is also reassuring.…”

Section: Transcarotid Approachmentioning

confidence: 99%

“…56 Conscious sedation with local anaesthesia or general anaesthesia are possible with the TS pathway. 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.…”

Section: Trans-subclavianmentioning

confidence: 99%

“…Two-year survival was also comparable (84 % after TS and 75 % in TA) although TA yielded higher perioperative mortality; the latter feature could be linked to a higher risk of major and life-threatening bleeding that was less frequent with the TS approach (11.5 %) than the TA approach (40.0 %). 47 The percutaneous approach is relatively recent. It has been reported to be feasible and safe in one German cohort of 100 high-risk patients, mostly through left axillary artery and under general anaesthesia.…”

Section: Trans-subclavianmentioning

confidence: 99%

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Alternate Access for TAVI: Stay Clear of the Chest

Overtchouk

Modine

2018

Interventional Cardiology Review

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Transcatheter aortic valve implantation (TAVI) is currently performed through an alternative access in 15 % of patients. The transapical access is progressively being abandoned as a result of its invasiveness and poor outcomes. Existing data does not allow TAVI operators to favour one access over another — between transcarotid, trans-subclavian and transaortic — because all have specific strengths and weaknesses. The percutaneous trans-subclavian access might become the main surgery-free alternative access, although further research is needed regarding its safety. Moreover, the difficult learning curve might compromise its adoption. The transcaval access is at an experimental stage and requires the development of dedicated cavo-aortic crossing techniques and closure devices.

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“…In this framework, Ciuca et al compared the outcomes of TS and TA access among 202 consecutive patients who underwent TAVR in three high‐volume Italian centers between 2008 and 2012 (TA/TS = 142/60 cases, ES/MC = 164/35 valves) . Patients’ demographics showed advanced age and high risk features (average STS score 9.3 ± 7.9%).…”

mentioning

confidence: 99%

The alternative approach to transcatheter aortic valve replacement

Kornowski

2016

Cathet Cardio Intervent

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Key Points An alternative route for transcatheter aortic valve replacement (TAVR) is needed whenever transfemoral vascular access is not feasible. The choice of alternative access differs between centers and depends mainly on the operators' preferences and site‐specific expertise of the “heart team.” In a multi‐center Italian Registry, the alternative access site (transapical vs. trans‐subclavian) was not an independent predictor of short‐ or long‐term mortality.

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Trans‐subclavian versus transapical access for transcatheter aortic valve implantation: A multicenter study

Abstract: Transapical compared with trans-subclavian access for TAVI was associated with a nonsignificant trend to increased periprocedural events. However, 1- and 2-year survival appears similar.

Cited by 52 publications

References 20 publications

Transcaval Access and Closure for Transcatheter Aortic Valve Replacement

Transcaval Access and Closure for Transcatheter Aortic Valve Replacement

Alternate Access for TAVI: Stay Clear of the Chest

The alternative approach to transcatheter aortic valve replacement

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