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01.09.2013 | Original Paper

Safety and efficacy of the subclavian access route for TAVI in cases of missing transfemoral access

verfasst von: Andrea Muensterer, Domenico Mazzitelli, Hendrik Ruge, Anke Wagner, Ina Hettich, Nicolo Piazza, Ruediger Lange, Sabine Bleiziffer

Erschienen in: Clinical Research in Cardiology | Ausgabe 9/2013

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Abstract

Objective

We retrospectively analysed our experience with the subclavian access transcatheter aortic valve implantation (TAVI) with the self-expandable CoreValve prosthesis and compared the results with transfemorally treated patients.

Background

For TAVI, a subclavian access is alternatively used when the femoral arteries are diseased or very small.

Methods

Between June 2007 and February 2011, 341 patients underwent CoreValve implantation in the German Heart Center, Munich through either transfemoral (n = 301) or subclavian (n = 40) approach. The subclavian approach was chosen where transfemoral approach was not possible.

Results

There was no difference in baseline characteristics between the groups. There were no significant differences between groups for parameters potentially related to improved valve positioning (contrast medium, fluoroscopy time, implantation of a second valve, post-implantation balloon dilatation, valve dislocation, pacemaker implantation, aortic regurgitation), while the procedure duration was longer (105 ± 40 vs. 82 ± 33 min, p = 0.001). With the Kaplan–Meier estimate, survival was not different among groups. Strokes, myocardial ischaemia, and access vessel complications occurred in 2.5, 0, and 7.5 % (subclavian group) vs. 4.3, 2.0, 10.6 % (transfemoral group), ns.

Conclusions

Our results demonstrate the safety of the subclavian access for TAVI and comparability with the transfemoral approach. With longer duration of the procedure and no significant advantages in clinical outcome, the subclavian access will have an indication for selected patients, while transfemoral TAVI should be considered first choice.

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Titel: Safety and efficacy of the subclavian access route for TAVI in cases of missing transfemoral access
verfasst von: Andrea Muensterer
Domenico Mazzitelli
Hendrik Ruge
Anke Wagner
Ina Hettich
Nicolo Piazza
Ruediger Lange
Sabine Bleiziffer
Publikationsdatum: 01.09.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 9/2013
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-013-0575-0

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Safety and efficacy of the subclavian access route for TAVI in cases of missing transfemoral access

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Methods

Results

Conclusions

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