AIMS: We describe an alternative access approach for patients undergoing transcatheter aortic valve implantation (TAVI) using surgical cut down of the distal axillary artery, in cases wherein transfemoral access is not feasible. METHODS: From January 2012 to July 2013, 61 patients (59% men; mean age 81 ± 8 years) underwent TAVI at our institution. The mean logistic EuroSCORE and EuroSCORE II were 36 ± 24 and 14 ± 10, respectively. We assessed device success, 30-day safety and clinical efficacy using VARC II criteria. RESULTS: TAVI was performed with the CoreValve Revalving System (CRS) (Medtronic Inc., Minneapolis, Minnesota, USA) in all cases, using transfemoral approach in 57 patients and distal trans-axillary route in four patients. A device was successfully implanted in 94%, without any major intraprocedural complications. One case of acute kidney disease, four cases of minor vascular complication and two cases of life-threatening bleeding occurred after the procedure for pericardial bleeding requiring pericardiocentesis. Permanent pacemaker was implanted in 26% of patients. There was no instance of in-hospital mortality, while two deaths (3%) occurred in the first 30 days. The total procedure time (skin-to-skin) was longer in the trans-axillary group secondary to surgical management of access site (P = 0.027), whereas revalving and fluoroscopy time were similar (P = 0.95 and P = 0.83, respectively). CONCLUSION: The location and anatomical relations of the distal axillary artery make it a safer, reproducible and operator friendly access option for TAVI.
Ussia, G., Cammalleri, V., ASCOLI MARCHETTI, A., Sarkar, K., DE VICO, P., Muscoli, S., et al. (2014). Transcatheter aortic valve implantation through distal axillary artery: novel option for vascular access. JOURNAL OF CARDIOVASCULAR MEDICINE [10.2459/JCM.0000000000000063].
|Tipologia:||Articolo su rivista|
|Citazione:||Ussia, G., Cammalleri, V., ASCOLI MARCHETTI, A., Sarkar, K., DE VICO, P., Muscoli, S., et al. (2014). Transcatheter aortic valve implantation through distal axillary artery: novel option for vascular access. JOURNAL OF CARDIOVASCULAR MEDICINE [10.2459/JCM.0000000000000063].|
|IF:||Con Impact Factor ISI|
|Settore Scientifico Disciplinare:||Settore MED/22 - Chirurgia Vascolare|
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
|Revisione (peer review):||Esperti anonimi|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.2459/JCM.0000000000000063|
|Stato di pubblicazione:||Online ahead of print|
|Data di pubblicazione:||2014|
|Titolo:||Transcatheter aortic valve implantation through distal axillary artery: novel option for vascular access|
|Autori:||Ussia, G; Cammalleri, V; ASCOLI MARCHETTI, A; Sarkar, K; DE VICO, P; Muscoli, S; Sergi, D; Marchei, M; Ippoliti, A; Romeo, F|
|Appare nelle tipologie:||01 - Articolo su rivista|