PERCUTANEOUS TRANSAXILLARY TRANSCATHETER AORTIC VALVE IMPLANTATION

Authors

  • J. Calheiros Department of Anesthesia, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, Portugal
  • A. Boa Department of Anesthesia, Centro Hospitalar de Vila Nova de Gaia/Espinho – Vila Nova de Gaia, Portugal
  • P. Braga Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho – Vila Nova de Gaia, Portugal
  • A. Rodrigues Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho – Vila Nova de Gaia, Portugal

DOI:

https://doi.org/10.48729/pjctvs.169

Keywords:

Percutaneous transaxillary approach, Percutaneous subclavian approach, Transcatheter aortic valve implantation

Abstract

The transaxillary (TAX) approach for transcatheter aortic valve implantation (TAVI) results in comparable short and long-term clinical results compared to the transfemoral (TF) approach. However, adequate closure of the axillary artery is the most critical issue when performing the percutaneous approach. Compared to surgical transaxillary approach, the percutaneous approach was used only in selected cases due to this closure limitation. In the present paper, we aim to demonstrate the feasibility of implanting the CoreValve Evolut Pro transcatheter heart valve via percutaneous transaxillary approach and make a literature review of procedure particularities and outcome. We describe the case of a patient with severe aortic stenosis in the presence of small calibre and severely calcified femoral arteries. A CoreValve Evolut Pro 26 was successfully implanted percutaneously through the left axillary artery. Percutaneous transaxillary transcatheter aortic valve implantation is a feasible and safe alternative in patients who have suboptimal iliofemoral vessels.

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References

Lanz, J., Greenbaum, A., Pilgrim, T., Centre, S. C., & Hospital, H. F. (n.d.). Current state of alternative access for transcatheter aortic valve implantation. EuroIntervention. 2018 Aug 31;14(AB):AB40-AB52. doi: 10.4244/EIJ-D-18-00552.

Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, Leipsic J, Hahn RT, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Genereux P, Pershad A, Pocock SJ, Alu MC, Webb JG, Smith CR; PARTNER 3 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019;380:1695–1705.

Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, Bajwa T, Heiser JC, Merhi W, Kleiman NS, Askew J, Sorajja P, Rovin J, Chetcuti SJ, Adams DH, Teirstein PS, Zorn GL, Forrest JK, Tchétché D, Resar J, Walton A, Piazza N, Ramlawi B, Robinson N, Petrossian G, Gleason TG, Oh JK, Boulware MJ, Qiao H, Mugglin AS, Reardon MJ; Evolut Low Risk Trial Investigators. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med 2019;380:1706–1715.

Schäfer, U., Deuschl, F., Schofer, N., Frerker, C., Schmidt, T., Kuck, K. H., Conradi, L. (2017). Safety and Efficacy of the Percutaneous Transaxillary Access for Transcatheter Aortic Valve Implantation using various Transcatheter Heart Valves in 100 Consecutive Patients. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2017.01.010

Amat-santos, I. J. (2018). Transubclavian approach: A competitive access for transcatheter aortic valve implantation as compared to transfemoral, (October 2017), 1–10. https://doi.org/10.1002/ccd.27485

Petronio, A., Giannini, C., Carlo, M., Caro, F., Bortolotti, U. (2019). Subclavian TAVI: more than an alternative access route., 24025955. https://doi.org/10.4244/EIJV9SSA7

Rogers, T., & Lederman, R. J. (2019). Percutaneous transaxillary access for TAVR: another opportunity to stay out of the chest, 91(1), 157–158. https://doi.org/10.1002/ccd.27458.

Schäfer U, Ho Y, Frerker C, Schewel D, Sanchez-Quintana D, Schofer J, Bijuklic K, Meincke F, Thielsen T, Kreidel F, Kuck KH. Direct percutaneous access technique for transaxillary transcatheter aortic valve implantation: “the Hamburg Sankt Georg approach”. JACC Cardiovasc Interv. 2012;5:477-86.

Palma, R. De. (2017). Percutaneous axillary arteriotomy closure during transcatheter aortic valve replacement

using the MANTA device, (July), 1–4. https://doi.org/10.1002/ccd.27383

Wiechen, M. P. Van, Ligthart, J. M., & Mieghem, N. M. Van. (2019). Structural Large-bore Vascular Closure : New Devices and Techniques, 17–21. https://doi.org/10.15420/icr.2018.36.1

Petronio AS, De Carlo M, Bedogni F, Marzocchi A, Klugmann S, Maisano F, Ramondo A, Ussia GP, Ettori F, Poli A, Brambilla N, Saia F, De Marco F, Colombo A. Safety and efficacy of the subclavian approach for transcatheter aortic valve implantation with the CoreValve revalving system. Circ Cardiovasc Interv. 2010;3:359-66.

Gleason TG, Schindler JT, Hagberg RC, Deeb GM, Adams DH, Conte JV, Zorn GL, Hughes GC, Guo J, Popma JJ, Reardon MJ. Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve Replacement Renders Equivalent Outcomes as Transfemoral. Ann Thorac Surg. 2018;105:477-83.

Brecker S. Result from the ADVANCE study. ESC 2012. Munich, Germany.

Amat-Santos IJ, Rojas P, Gutiérrez H, Vera S, Castrodeza J, Tobar J, Goncalves-Ramirez LR, Carrasco M, Catala P, San Román JA. Transubclavian approach: A competitive access for transcatheter aortic valve implantation as compared to transfemoral. Catheter Cardiovasc Interv. 2018 Jan 3.

McCabe J, Khaki A, Nicholson W, Blank N, Grantham JA, Lombardi W, Tayal R. TCT-99 safety and efficacy of percutaneous axillary artery access for mechanical circulatory support with the Impella© devices: an initial evaluation from the axillary access registry to monitor safety (ARMS) multiCenter registry. J Am Coll Cardiol. 2017;70:B43. DOI: 10.1016/j. jacc.2017.09.1123

Ben-dor, I., Looser, P. M., Maluenda, G., Weddington, T. C., Kambouris, N. G., Barbash, I. M. Waksman, R. (2012). Transcatheter aortic valve replacement under monitored anesthesia care versus general anesthesia with intubation. Cardiovascular Revascularization Medicine, 13(4), 207–210. https://doi.org/10.1016/j.carrev.2012.02.002

Mathur, M., Krishnan, S. K., Levin, D., Aldea, G., Mccabe, J. M., Mathur, M., Aldea, G. (2017). A Step-by-Step Guide to Fully Percutaneous Transaxillary Transcatheter Aortic Valve Replacement A Step-by-Step Guide to Fully Percutaneous Transaxillary Transcatheter Aortic Valve. Structural Heart, 1(5–6), 209–215. https://doi.org/10.1080/24748706.2017.1370156

Grubb KJ, Fields T, Cheng A, Settles DM, Stoddard M, Flaherty MP (2016). Transaxillary Transcatheter Aortic Valve Replacement with a Self-Expanding Valve under Conscious Sedation : Case Discussion and Review of the Literature, Clinics in Surgery 1, 1–6.

Ruggeri, L., Gerli, C., Franco, A., Barile, L., Magnano, M. S., Lio, S.,Zangrillo, A. (2012). Anesthetic management for percutaneous aortic valve implantation : an overview of worldwide experiences. HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2012; 4(1): 40-46

Melidi, E., Latsios, G., Toutouzas, K., Vavouranakis, M., Tolios, I., Gouliami, M. Tousoulis, D. (2016). Cardio-anesthesiology considerations for the trans-cathe ter aortic valve implantation. Hellenic Journal of Cardiology, 57(6), 401–406. https://doi.org/10.1016/j.hjc.2016.10.001

Overtchouk, P., & Modine, T. (2018). Structural Alternate Access for TAVI : Stay Clear of the Chest, 145–150.

Mack, M. J. (2012). Access for Transcatheter Aortic Valve Replacement, 5(5). https://doi.org/10.1016/j.jcin.2012.03.009

Hamburg, T., & Georg, S. (2012). Direct Percutaneous Access Technique for Transaxillary Transcatheter Aortic Valve Implantation, 5(5). https://doi.org/10.1016/j.jcin.2011.11.014

Fraccaro, C., Napodano, M., Tarantini, G., Gasparetto, V., Gerosa, G., Bianco, R. Isabella, G. (2019). Expanding the eligibility for transcatheter aortic valve implantation the trans-subclavian retrograde approach using: the III generation CoreValve revalving system., 2(9), 19778770. https://doi.org/10.1016/j.jcin.2009.06.016

Oteo JF, Trillo R, García-Touchard A, Fernández-Díaz JA, Cavero MA, Goicolea J. A first case of totally percutaneous transaxillary aortic valve implantation. Rev Esp Cardiol (Engl Ed). 2013 Mar;66(3):220-2. doi: 10.1016/j.rec.2012.06.012. Epub 2012 Oct 4.

Bojara, W., Gerckens, U., & Fritz, M. (2009). Implantation of the CoreValve self-expanding valve prosthesis via a subclavian artery approach : a case report, 204, 201–204. https://doi.org/10.1007/s00392-009-0750-5

Bruschi, G., Fratto, P., Marco, F. De, Oreglia, J., Colombo, P., Botta, L., Klugmann, S. (2009). The trans-subclavian retrograde approach for transcatheter aortic valve replacement: Single-center experience. The Journal of Thoracic and Cardiovascular Surgery, 140(4), 911–915. e2. https://doi.org/10.1016/j.jtcvs.2010.01.027

Bruschi, G., Marco, F. De, Fratto, P., Oreglia, J., Colombo, P., Botta, L. Martinelli, L., (2011). Alternative approaches for trans-catheter self-expanding aortic bioprosthetic valves implantation: single-center experience §. European Journal of Cardio-Thoracic Surgery, 39(6), e151–e158. https://doi.org/10.1016/j.ejcts.2011.01.014

Caceres, M., Braud, R., & Roselli, E. E. (2012). The Axillary / Subclavian Artery Access Route for Transcatheter Aortic Valve Replacement : A Systematic Review of the Literature. ATS, 93(3), 1013–1018. https://doi.org/10.1016/j.athoracsur.2011.10.056

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Published

02-07-2021

How to Cite

1.
Calheiros J, Boa A, Braga P, Rodrigues A. PERCUTANEOUS TRANSAXILLARY TRANSCATHETER AORTIC VALVE IMPLANTATION. Rev Port Cir Cardiotorac Vasc [Internet]. 2021 Jul. 2 [cited 2024 Apr. 26];28(2):49-57. Available from: https://pjctvs.com/index.php/journal/article/view/169

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Section

Clinical Cases