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Transcatheter aortic valve implantation through distal axillary artery: novel option for vascular access

Ussia, Gian Paolo; Cammalleri, Valeria; Marchetti, Andrea Ascoli; Sarkar, Kunal; De Vico, Pasquale; Muscoli, Saverio; Sergi, Domenico; Marchei, Massimo; Ippoliti, Arnaldo; Romeo, Francesco

Journal of Cardiovascular Medicine: April 2015 - Volume 16 - Issue 4 - p 271–278
doi: 10.2459/JCM.0000000000000063
Original articles

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.

aDepartment of Cardiovascular Disease

bDepartment of Vascular Surgery

cDepartment of Anaesthesiology, University of Rome Tor Vergata, Rome, Italy

Correspondence to Gian Paolo Ussia, MD, Department of Cardiovascular Disease, University of Rome Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy Tel: +390620904009; fax: +390620904008; e-mail:

Received 23 July, 2013

Revised 20 February, 2014

Accepted 20 February, 2014

© 2015 Italian Federation of Cardiology. All rights reserved.